Provider Demographics
NPI:1043574197
Name:GONZALES, COLVERT ROMULO (OD)
Entity Type:Individual
Prefix:DR
First Name:COLVERT
Middle Name:ROMULO
Last Name:GONZALES
Suffix:
Gender:M
Credentials:OD
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Other - Credentials:
Mailing Address - Street 1:757 PACIFIC ST
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-2819
Mailing Address - Country:US
Mailing Address - Phone:831-372-8181
Mailing Address - Fax:831-372-7433
Practice Address - Street 1:757 PACIFIC ST
Practice Address - Street 2:SUITE C-1
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2819
Practice Address - Country:US
Practice Address - Phone:831-372-8181
Practice Address - Fax:831-372-7433
Is Sole Proprietor?:No
Enumeration Date:2012-07-03
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA14682152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist