Provider Demographics
NPI:1639262645
Name:GOMEZ, PETER L (OD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:L
Last Name:GOMEZ
Suffix:
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 1:8940 N KENDALL DR
Mailing Address - Street 2:STE 703F
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176
Mailing Address - Country:US
Mailing Address - Phone:305-279-3400
Mailing Address - Fax:305-279-3988
Practice Address - Street 1:8940 N KENDALL DR
Practice Address - Street 2:STE 703E
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176
Practice Address - Country:US
Practice Address - Phone:305-279-3400
Practice Address - Fax:305-279-3988
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3345152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL23007OtherBCBS
FL620641700Medicaid
U91289Medicare UPIN
FLE7828AMedicare ID - Type Unspecified