Provider Demographics
NPI:1881197374
Name:GONZALES, MELISSA GOMEZ (OD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:GOMEZ
Last Name:GONZALES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:4118 COTT ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-3119
Mailing Address - Country:US
Mailing Address - Phone:361-728-5340
Mailing Address - Fax:
Practice Address - Street 1:1540A WILDCAT DR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-2814
Practice Address - Country:US
Practice Address - Phone:361-643-1516
Practice Address - Fax:361-643-7479
Is Sole Proprietor?:No
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9280TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist