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General NPI Number Information
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NPI Number | 1528030780
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Entity Type | Individual
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Provider Name | CLINT ERIC GONZALES OD
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Gender | Male
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Dates
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Enumeration Date | 02/02/2006
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Last Update Date | 03/30/2021
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Provider Practice Location Address
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Address Line | 22659 HWY 59 NORTH 100
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City | KINGWOOD
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State | TX
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Zip | 77339
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Country | US
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Telephone | 281-858-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 2855 GRAMERCY ST # 400
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City | HOUSTON
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State | TX
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Zip | 77025-1756
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Country | US
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Telephone | 713-668-6828
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 6215TG
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License Number State | TX
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