Healthcare Provider Details

I. General information

NPI: 1184299281
Provider Name (Legal Business Name): RENEE M GOMEZ-CHLEBICA OD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 N MAIN ST
BELCHERTOWN MA
01007-9433
US

IV. Provider business mailing address

109 MASONIC HOME RD # 6
CHARLTON MA
01507-6301
US

V. Phone/Fax

Practice location:
  • Phone: 413-323-1196
  • Fax: 413-323-1186
Mailing address:
  • Phone: 774-573-1370
  • Fax: 508-248-1188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: RENEE MIGNON GOMEZ CHLEBICA
Title or Position: OWNER
Credential: OD
Phone: 508-248-1188