Provider Demographics
NPI:1891920187
Name:GOMESINDO E. HENDRICKS LTD
Entity Type:Organization
Organization Name:GOMESINDO E. HENDRICKS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GOMESINDO
Authorized Official - Middle Name:E
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-565-0555
Mailing Address - Street 1:61 E LAKE MEAD PKWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89015-5531
Mailing Address - Country:US
Mailing Address - Phone:702-565-0555
Mailing Address - Fax:
Practice Address - Street 1:61 E LAKE MEAD PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-5531
Practice Address - Country:US
Practice Address - Phone:702-565-0555
Practice Address - Fax:702-564-6060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-15
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV0196152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVFS588ZOtherPTAN ASSOCIATED WITH PERSONAL NPI 1316999436
NV0168770001Medicare NSC
NVVOD196Medicare PIN