MEDICARE: MS. LOURDES SALLY NUNEZ-GOMEZ DO

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	156FX1800X	Optician	DO 5138	FL

General Provider Information

NPI Number	:	1508077223
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LOURDES SALLY NUNEZ-GOMEZ DO

Provider Business Mailing Address
First Line	:	PO BOX 452452
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33245-2452
Country	:	US
Telephone Number	:	305-371-2252
Fax Number	:

Provider Business Practice Location Address
First Line	:	3661 S MIAMI AVE STE 110
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-4206
Country	:	US
Telephone Number	:	305-371-2252
Fax Number	:

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

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	01/12/2026

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