Provider Demographics
NPI:1174120083
Name:GONZALES, PABLO III (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:PABLO
Middle Name:
Last Name:GONZALES
Suffix:III
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10114 STELLA LINK RD STE A-2
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-5300
Mailing Address - Country:US
Mailing Address - Phone:713-808-9053
Mailing Address - Fax:713-893-6916
Practice Address - Street 1:10114 STELLA LINK RD STE A-2
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-5300
Practice Address - Country:US
Practice Address - Phone:713-808-9053
Practice Address - Fax:713-893-6916
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-04
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX156FX1800X
156FC0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty