MEDICARE: DR. CHRISTINA MARIE GONZALEZ 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	2356	CT

General Provider Information

NPI Number	:	1831219278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTINA MARIE GONZALEZ O.D.

Provider Business Mailing Address
First Line	:	6 BOTTICELLO DR
Second Line	:
City	:	MANCHESTER
State	:	CT
Zip	:	06042-1675
Country	:	US
Telephone Number	:	860-648-1182
Fax Number	:

Provider Business Practice Location Address
First Line	:	69 PROSPECT HILL RD
Second Line	:
City	:	EAST WINDSOR
State	:	CT
Zip	:	06088-3600
Country	:	US
Telephone Number	:	860-623-8013
Fax Number	:	860-627-6433

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

Provider Enumeration Date	:	03/30/2007
Last Update Date	:	07/08/2007

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