Organization
GREGORY L HENDERSON MD FACS INC
Active
Parent organization
GREGORY L HENDERSON MD FACS INC
Other names
Florida Eye Specialist and Cataract Institute
Organization subpart
Yes
Provider details
NPI number
Legal business name
GREGORY L HENDERSON MD FACS INC
Authorized official
MR. GREGORY L HENDERSON SR. MD (PRESIDENT)
(813) 681-1122
Entity
Organization
Contact information
Practice address
612 N TAMIAMI TRL, RUSKIN, FL 33570-3769
(813) 645-3831
(813) 645-4402
Mailing address
403 VONDERBURG DR, BRANDON, FL 33511-5982
(813) 681-1122
(813) 684-4924
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
207W00000X
Ophthalmology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
060983801
—
FL
Enumeration date
08/31/2005
Last updated
09/19/2017
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