Provider Demographics
NPI:1174835276
Name:HENTZ, GLORIA L (OD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:L
Last Name:HENTZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8095
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76124-0095
Mailing Address - Country:US
Mailing Address - Phone:817-877-3937
Mailing Address - Fax:817-877-3939
Practice Address - Street 1:5335 W SUBLETT RD STE 131
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76017-1184
Practice Address - Country:US
Practice Address - Phone:817-200-3939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-06
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7560T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist