Provider Demographics
NPI:1508123191
Name:HENDERSON OPTICAL
Entity Type:Organization
Organization Name:HENDERSON OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPHTHALMOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRUHL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:817-596-0277
Mailing Address - Street 1:804 SANTA FE DR
Mailing Address - Street 2:STE 100
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-6525
Mailing Address - Country:US
Mailing Address - Phone:817-596-0277
Mailing Address - Fax:817-594-0166
Practice Address - Street 1:804 SANTA FE DR
Practice Address - Street 2:STE 100
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6525
Practice Address - Country:US
Practice Address - Phone:817-596-0277
Practice Address - Fax:817-594-0166
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HENDERSON OPTICAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-04-19
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty