Provider Demographics
NPI:1952660813
Name:GONZALEZ, ANTHONY (ABOC)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 S. SANTA CLARA STREET
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274
Mailing Address - Country:US
Mailing Address - Phone:661-778-4117
Mailing Address - Fax:
Practice Address - Street 1:9700 BRIMHALL RD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-2777
Practice Address - Country:US
Practice Address - Phone:661-631-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-14
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASL 6268156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician