MEDICARE: DR. EFREN ALEJANDRO GOMEZ O.D.

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
1	152W00000X	Optometrist	18003645A	IN

Other Identifiers

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

General Provider Information

NPI Number	:	1639483936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EFREN ALEJANDRO GOMEZ O.D.

Provider Business Mailing Address
First Line	:	1703 CALUMET AVE
Second Line	:	SUITE B
City	:	WHITING
State	:	IN
Zip	:	46394-1414
Country	:	US
Telephone Number	:	219-659-1105
Fax Number	:

Provider Business Practice Location Address
First Line	:	1703 CALUMET AVE
Second Line	:	SUITE B
City	:	WHITING
State	:	IN
Zip	:	46394-1414
Country	:	US
Telephone Number	:	219-659-1105
Fax Number	:	219-659-4855

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2010
Last Update Date	:	06/22/2020

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