Provider Demographics
NPI:1013558840
Name:VILLAGOMEZ, CRISTIAN (ABOC)
Entity Type:Individual
Prefix:MR
First Name:CRISTIAN
Middle Name:
Last Name:VILLAGOMEZ
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 KAZMEIER PLZ
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-3414
Mailing Address - Country:US
Mailing Address - Phone:713-377-0597
Mailing Address - Fax:
Practice Address - Street 1:2128 KAZMEIER PLZ
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-3414
Practice Address - Country:US
Practice Address - Phone:713-377-0597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician