Provider Demographics
NPI:1225523574
Name:GONZALES, CLARISSA (OD)
Entity Type:Individual
Prefix:DR
First Name:CLARISSA
Middle Name:
Last Name:GONZALES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 S 10TH ST STE B6
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-5435
Mailing Address - Country:US
Mailing Address - Phone:956-682-4459
Mailing Address - Fax:
Practice Address - Street 1:2200 S 10TH ST STE B6
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-5435
Practice Address - Country:US
Practice Address - Phone:956-668-2445
Practice Address - Fax:956-630-4139
Is Sole Proprietor?:No
Enumeration Date:2018-06-28
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9534T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist