Provider Demographics
NPI:1730436155
Name:A GOMES OPTOMETRY APC
Entity type:Organization
Organization Name:A GOMES OPTOMETRY APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRY/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEJANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:818-988-8744
Mailing Address - Street 1:5622 VAN NUYS BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-4602
Mailing Address - Country:US
Mailing Address - Phone:818-988-8744
Mailing Address - Fax:818-988-8756
Practice Address - Street 1:5622 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-4602
Practice Address - Country:US
Practice Address - Phone:818-988-8744
Practice Address - Fax:818-988-8756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty