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NPI Code Detail

MEDICARE: DR. MARCUS B GONZALES OD

MEDICARE: DR. MARCUS B GONZALES OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist6930TGTX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417147596
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARCUS B GONZALES OD
Provider Business Mailing Address
First Line : 4901 CALHOUN RD RM 2104
Second Line :
City : HOUSTON
State : TX
Zip : 77204-2020
Country : US
Telephone Number : 713-743-2020
Fax Number : 713-743-0963
Provider Business Practice Location Address
First Line : 2525 LUCAS DR
Second Line : BLG 3
City : DALLAS
State : TX
Zip : 75219-1804
Country : US
Telephone Number : 214-528-7354
Fax Number : 214-528-7387
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2007
Last Update Date : 12/22/2025

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