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MARIO J GONZALES OD
>> Optometrist >> Eye and Vision Services ProvidersRegistrant NPI Number: 1427014166
Individual Registrant: MARIO J GONZALES OD
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
1369 SYCAMORE AVE HERCULES, CA 94547-5489 US
Tel: 510-592-1630 Fax: 510-724-0202
Tel: 510-592-1630 Fax: 510-724-0202
Contact information for business:
1369 SYCAMORE AVE HERCULES, CA 94547-5489 US
Tel: 510-592-1630 Fax: 510-724-0202
Tel: 510-592-1630 Fax: 510-724-0202
Registration Information:
NPI: 1427014166
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 152W00000X | Eye and Vision Services Providers Optometrist | NM | 473 |
| Y | 152W00000X | Eye and Vision Services Providers Optometrist | CA | 10797 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
