Provider Demographics
NPI:1922305192
Name:GONZALEZ, MARCO ANTONIO (OD)
Entity Type:Individual
Prefix:
First Name:MARCO
Middle Name:ANTONIO
Last Name:GONZALEZ
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:P O BOX 790
Mailing Address - Street 2:
Mailing Address - City:PARLIER
Mailing Address - State:CA
Mailing Address - Zip Code:93648-2639
Mailing Address - Country:US
Mailing Address - Phone:559-876-6703
Mailing Address - Fax:559-876-6705
Practice Address - Street 1:1560 E MANNING AVE
Practice Address - Street 2:
Practice Address - City:REEDLEY
Practice Address - State:CA
Practice Address - Zip Code:93654
Practice Address - Country:US
Practice Address - Phone:559-638-2019
Practice Address - Fax:559-638-2136
Is Sole Proprietor?:No
Enumeration Date:2011-02-23
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15034152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist