Provider Demographics
NPI:1346234150
Name:GONZALEZ AVILES, ANDRES SR (OD)
Entity Type:Individual
Prefix:MR
First Name:ANDRES
Middle Name:
Last Name:GONZALEZ AVILES
Suffix:SR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:380 CALLE LA GUADALUPE
Mailing Address - Street 2:
Mailing Address - City:MOCA
Mailing Address - State:PR
Mailing Address - Zip Code:00676-4316
Mailing Address - Country:US
Mailing Address - Phone:787-604-7573
Mailing Address - Fax:
Practice Address - Street 1:380 CALLE LA GUADALUPE
Practice Address - Street 2:
Practice Address - City:MOCA
Practice Address - State:PR
Practice Address - Zip Code:00676-4316
Practice Address - Country:US
Practice Address - Phone:787-604-7573
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR615-0117152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist