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General NPI Number Information
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NPI Number | 1720150915
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Entity Type | Individual
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Provider Name | BRIAN ANTHONY GONZALES O.D.
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Gender | Male
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 06/18/2019
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Provider Practice Location Address
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Address Line | 2002 MEDICAL PKWY STE 320
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7901
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Country | US
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Telephone | 410-571-8733
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Fax |
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Provider Business Mailing Address
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Address Line | 1506 MCABBOTT CT
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City | SEVERN
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State | MD
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Zip | 21144-3444
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Country | US
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Telephone | 410-551-6315
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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 | TA1622
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License Number State | MD
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