MEDICARE: DR. CONSUELO ELIZABETH CHAVEZ-GOMEZ OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	VUT006194	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	922825	OTHER	NY	BLOCK
2	NY6871	OTHER	NY	EYEMED
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	3101581	OTHER	NY	UNITED HEALTHCARE
5	T006194	OTHER	NY	METROPLUS
6	52743	OTHER	NY	DAVIS
7	OV27627	OTHER	NY	SPECTERA

General Provider Information

NPI Number	:	1013080415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CONSUELO ELIZABETH CHAVEZ-GOMEZ OD

Provider Business Mailing Address
First Line	:	7508 37TH AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-6538
Country	:	US
Telephone Number	:	718-476-1458
Fax Number	:	718-476-1462

Provider Business Practice Location Address
First Line	:	7508 37TH AVE
Second Line	:
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-6538
Country	:	US
Telephone Number	:	718-476-1458
Fax Number	:	718-476-1462

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2006
Last Update Date	:	03/01/2013

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Directions to “ DR. CONSUELO ELIZABETH CHAVEZ-GOMEZ OD” Practice Location

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