Provider Demographics
NPI:1992468581
Name:LUNA, GABRIELLE CONNIE (OD)
Entity Type:Individual
Prefix:
First Name:GABRIELLE
Middle Name:CONNIE
Last Name:LUNA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16735 LA CANTERA PKWY APT 16301
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78256-1798
Mailing Address - Country:US
Mailing Address - Phone:210-373-2868
Mailing Address - Fax:
Practice Address - Street 1:17323 IH 35 N STE 110
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-1278
Practice Address - Country:US
Practice Address - Phone:210-651-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-20
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10348152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist