Provider Demographics
NPI:1629396015
Name:GOMEZ, LORRAINE
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10701 MONTGOMERY BLVD NE
Mailing Address - Street 2:SUITE L
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3816
Mailing Address - Country:US
Mailing Address - Phone:505-828-0828
Mailing Address - Fax:505-828-0848
Practice Address - Street 1:4201 CENTRAL AVE NE
Practice Address - Street 2:#B2
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-1630
Practice Address - Country:US
Practice Address - Phone:505-836-4322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-10
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician