Provider Demographics
NPI:1316999436
Name:HENDRICKS, GOMESINDO EDWARD (OD)
Entity type:Individual
Prefix:DR
First Name:GOMESINDO
Middle Name:EDWARD
Last Name:HENDRICKS
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 1:61 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:702-565-7579
Mailing Address - Fax:702-564-6060
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:702-565-7579
Practice Address - Fax:702-564-6060
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV0196152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVU10994Medicare UPIN
NVFS588ZMedicare PIN