Healthcare Provider Details

I. General information

NPI: 1811277163
Provider Name (Legal Business Name): RENEE MIGNON GOMEZ CHLEBICA O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RENEE MIGNON GOMEZ OD

II. Dates (important events)

Enumeration Date: 08/18/2011
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

67 HALL RD STE 2
STURBRIDGE MA
01566-1473
US

IV. Provider business mailing address

67 HALL RD STE 2
STURBRIDGE MA
01566-1473
US

V. Phone/Fax

Practice location:
  • Phone: 508-978-1923
  • Fax: 508-463-9973
Mailing address:
  • Phone: 267-625-3156
  • Fax: 508-463-9973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4813
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: