Provider Demographics
NPI:1356340863
Name:GASSEN, VINCENT (OD)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:GASSEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 WIGWAM PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-8195
Mailing Address - Country:US
Mailing Address - Phone:702-485-5000
Mailing Address - Fax:702-485-5001
Practice Address - Street 1:1505 WIGWAM PKWY STE 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-8195
Practice Address - Country:US
Practice Address - Phone:702-896-6043
Practice Address - Fax:702-896-9591
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV364152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1356340863Medicaid
U78751Medicare UPIN
NV002502047Medicaid