Provider Demographics
NPI:1831835289
Name:GONZALEZ, NIKKI (OD)
Entity type:Individual
Prefix:DR
First Name:NIKKI
Middle Name:
Last Name:GONZALEZ
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1116 VOLVO PKWY STE 102
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-2803
Mailing Address - Country:US
Mailing Address - Phone:757-426-2020
Mailing Address - Fax:
Practice Address - Street 1:1116 VOLVO PKWY STE 102
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-2803
Practice Address - Country:US
Practice Address - Phone:757-426-2020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-09
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC6233152W00000X
MA5541152W00000X
VA0618003225152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist