Provider Demographics
NPI:1699257881
Name:GATES, HENRY (OD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:GATES
Suffix:
Gender:
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:US ARMY MEDDAC BAVARIA
Mailing Address - Street 2:CMR 411 UNIT 28037
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3636 UNIVERSITY BLVD S STE A2
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4210
Practice Address - Country:US
Practice Address - Phone:904-739-0606
Practice Address - Fax:904-739-0609
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-04
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2060152W00000X
FL6582152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist