Healthcare Provider Details

I. General information

NPI: 1497851398
Provider Name (Legal Business Name): GABRIEL COLON O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2190 N NORCROSS TUCKER RD STE 102
NORCROSS GA
30071-3458
US

IV. Provider business mailing address

2190 N NORCROSS TUCKER RD STE 102
NORCROSS GA
30071-3458
US

V. Phone/Fax

Practice location:
  • Phone: 770-414-0020
  • Fax: 770-414-0233
Mailing address:
  • Phone: 770-414-0020
  • Fax: 770-414-0233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT002226
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: