Provider Demographics
NPI:1962654376
Name:GOMEZ, EMMA TART (LICENSE OPTICIAN)
Entity Type:Individual
Prefix:MRS
First Name:EMMA
Middle Name:TART
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:LICENSE OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7005 E WILKINSON
Mailing Address - Street 2:SUITE D
Mailing Address - City:BELMONT
Mailing Address - State:NC
Mailing Address - Zip Code:28012-6227
Mailing Address - Country:US
Mailing Address - Phone:704-825-8063
Mailing Address - Fax:704-825-8064
Practice Address - Street 1:7005 E WILKINSON
Practice Address - Street 2:SUITE D
Practice Address - City:BELMONT
Practice Address - State:NC
Practice Address - Zip Code:28012-6227
Practice Address - Country:US
Practice Address - Phone:704-825-8063
Practice Address - Fax:704-825-8064
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1171156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician