Healthcare Provider Details

I. General information

NPI: 1326460197
Provider Name (Legal Business Name): JAMES N GOMEZ OD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 10/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5885 KINGSTOWNE BLVD
ALEXANDRIA VA
22315-5702
US

IV. Provider business mailing address

5885 KINGSTOWNE BLVD
ALEXANDRIA VA
22315-5702
US

V. Phone/Fax

Practice location:
  • Phone: 703-842-0248
  • Fax:
Mailing address:
  • Phone: 703-842-0248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618000627
License Number StateVA

VIII. Authorized Official

Name: DR. JAMES N GOMEZ
Title or Position: OPTOMETRIST
Credential: OD
Phone: 703-842-0248