Provider Demographics
NPI:1811277163
Name:GOMEZ CHLEBICA, RENEE MIGNON (OD)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:MIGNON
Last Name:GOMEZ CHLEBICA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:MIGNON
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 JAYNES WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLTON
Mailing Address - State:MA
Mailing Address - Zip Code:01507-1663
Mailing Address - Country:US
Mailing Address - Phone:267-625-3156
Mailing Address - Fax:
Practice Address - Street 1:109 MASONIC HOME RD # 6
Practice Address - Street 2:
Practice Address - City:CHARLTON
Practice Address - State:MA
Practice Address - Zip Code:01507-6301
Practice Address - Country:US
Practice Address - Phone:508-248-1188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2019-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4813152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist