Healthcare Provider Details

I. General information

NPI: 1619642808
Provider Name (Legal Business Name): VERONICA JANETTE GONZALEZ OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2021
Last Update Date: 05/16/2022
Certification Date: 05/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3968 SW ARCHER RD STE W101
GAINESVILLE FL
32608-2342
US

IV. Provider business mailing address

1950 OLD GALLOWS RD STE 520
VIENNA VA
22182-3970
US

V. Phone/Fax

Practice location:
  • Phone: 352-376-6622
  • Fax: 352-376-1786
Mailing address:
  • Phone: 703-847-8899
  • Fax: 571-223-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC5947
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: