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MARIO J GONZALES OD

>> Optometrist >> Eye and Vision Services Providers

Registrant NPI Number: 1427014166

Individual Registrant:
 MARIO J GONZALES OD
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

Contact information for business:
1369 SYCAMORE AVE  HERCULES, CA 94547-5489 US
Tel: 510-592-1630  Fax: 510-724-0202

Registration Information:
NPI: 1427014166
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N152W00000XEye and Vision Services Providers
Optometrist
NM473
Y152W00000XEye and Vision Services Providers
Optometrist
CA10797

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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