Provider Demographics
NPI:1942397237
Name:THOMAS HENDERSON MANAGEMENT LLC
Entity Type:Organization
Organization Name:THOMAS HENDERSON MANAGEMENT LLC
Other - Org Name:EYE CLINIC OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:T
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-427-1100
Mailing Address - Street 1:3410 FAR WEST BOULEVARD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3167
Mailing Address - Country:US
Mailing Address - Phone:512-427-1100
Mailing Address - Fax:512-427-1208
Practice Address - Street 1:3410 FAR WEST BOULEVARD
Practice Address - Street 2:SUITE 140
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3167
Practice Address - Country:US
Practice Address - Phone:512-427-1100
Practice Address - Fax:512-427-1208
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THOMAS HENDERSON MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-06
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612710001OtherNATIONAL SUPPLIER CLEARIN
TX612710001OtherNATIONAL SUPPLIER CLEARIN