NPIMap

Organization Active NPI

Gregory L Henderson MD Facs Inc

  • Ophthalmology Physician
  • Tampa, FL
National Provider Identifier
1952139347
Registry record updated Jul 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
Legal business name
GREGORY L HENDERSON MD FACS INC
Practice address
3115 W Swann Ave
Tampa, FL 33609-4617
Phone
(813) 492-2020
Fax
(813) 492-2099
NPI assigned
Jul 25, 2024
Last updated
Jul 25, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Gregory L Henderson Sr., M.D.NPI 1427055227
Title
President
Phone
(813) 681-1122

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X Primary

Addresses

Primary practice location

3115 W Swann Ave
Tampa, FL 33609-4617

Mailing address

403 Vonderburg Dr
Brandon, FL 33511
Phone (813) 681-1122

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250305001457 FL DME Supplier - Physician - Optometrist 9739172321 Practice locations: Tampa, FL

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2321004Gregory L Henderson, MD, Facs, Inc3115 W Swann Ave, Tampa, FL 33609Certificate of waiverMar 26, 2027

Medicare medical equipment & supply locations

SupplierSuppliesMedicare assignment
Gregory L Henderson MD Facs Inc3115 W Swann Ave, Tampa, FL 33609-4617(813) 492-2020 Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses Accepts assignmentParticipating since Jan 1, 2002

National Provider Directory

National Provider Directory
Tax ID family
Gregory L Henderson MD Facs3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Locations

135 W Robertson St
Fl Eye
Brandon, FL 33511
Phone (813) 681-1122

403 Vonderburg Dr
Ste 101
Brandon, FL 33511
Phone (813) 681-1122

655 Brandon Town Center Mall
Fl Eye
Brandon, FL 33511
Phone (813) 651-0113

2002 S Alexander St
Plant City, FL 33563
Phone (813) 754-3593

6152 Delancey Station St
Riverview, FL 33578
Phone (813) 693-6955

612 N US Highway 41
Fl Eye
Ruskin, FL 33570
Phone (813) 645-3831

4051 Upper Creek Dr
Ste 107
Sun City Center, FL 33573
Phone (813) 634-2266

3115 W Swann Ave
Fl Eye
Tampa, FL 33609
Phone (813) 492-2020

Practitioners & affiliated clinicians

Practitioners 56

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 56

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1721865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721865600000",
    "number": "1952139347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 VONDERBURG DR",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "33511",
            "telephone_number": "813-681-1122",
            "fax_number": "813-684-4924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3115 W SWANN AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336094617",
            "telephone_number": "813-492-2020",
            "fax_number": "813-492-2099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREGORY L HENDERSON MD FACS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-07-25",
        "last_updated": "2024-07-25",
        "status": "A",
        "authorized_official_last_name": "HENDERSON",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "813-681-1122",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.