Provider Demographics
NPI:1669485199
Name:GOMEZ, JAMES N
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:N
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5885 KINGSTOWNE BLVD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-5702
Mailing Address - Country:US
Mailing Address - Phone:703-842-0248
Mailing Address - Fax:
Practice Address - Street 1:5885 KINGSTOWNE BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5702
Practice Address - Country:US
Practice Address - Phone:703-842-0248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOP1000265152W00000X
VA0618000627152W00000X
FLTPOP123152W00000X
NE1566152W00000X
WI3737-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist