Provider Demographics
NPI:1497919765
Name:GOMES, ALEJANDRO (OD)
Entity Type:Individual
Prefix:DR
First Name:ALEJANDRO
Middle Name:
Last Name:GOMES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:ALEX
Other - Middle Name:
Other - Last Name:GOMES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:5622 VAN NUYS BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-4602
Mailing Address - Country:US
Mailing Address - Phone:818-988-8744
Mailing Address - Fax:818-988-8756
Practice Address - Street 1:26506 BOUQUET CANYON RD
Practice Address - Street 2:
Practice Address - City:SAUGUS
Practice Address - State:CA
Practice Address - Zip Code:91350-2353
Practice Address - Country:US
Practice Address - Phone:661-297-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2013-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13501152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist