Provider Demographics
NPI:1558398420
Name:GONZALEZ, DIANA (OD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:
Last Name:GONZALEZ
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 1:21126 MARKET RDG
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4984
Mailing Address - Country:US
Mailing Address - Phone:210-305-5555
Mailing Address - Fax:210-402-5435
Practice Address - Street 1:21126 MARKET RDG
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4984
Practice Address - Country:US
Practice Address - Phone:210-305-5555
Practice Address - Fax:210-402-5435
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-27
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5906TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTX5906OtherEYEMED, ECPA
TX18978Other20/20 SELECT, LIFERE
TX33093OtherAVESIS
TX55748OtherSAFEGURAD/SAFEHEALTH
TX24855OtherSPECTERA
TX451909OtherNATIONAL VISION ADMINISTR
TXGO1319495OtherCLARITY
TX13622OtherHUMANA
TX81168QOtherBLUE CROSS BLUE SHIELD
TXSUPERIOROther1371
TX44973OtherDAVIS
TX24855OtherSPECTERA
TX44973OtherDAVIS