MEDICARE: DR. MARISSA 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	OEG003748	PA
2	152W00000X	Optometrist	TA2778	MD
3	152W00000X	Optometrist	10171TG	TX

General Provider Information

NPI Number	:	1720677396
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARISSA GOMEZ OD

Provider Business Mailing Address
First Line	:	6909 N LOOP 1604 E STE 1113
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-5306
Country	:	US
Telephone Number	:	210-651-0985
Fax Number	:

Provider Business Practice Location Address
First Line	:	6909 N LOOP 1604 E STE 1113
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-5306
Country	:	US
Telephone Number	:	210-651-0985
Fax Number	:

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

Provider Enumeration Date	:	01/18/2021
Last Update Date	:	01/12/2022

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Directions to “ DR. MARISSA GOMEZ OD” Practice Location

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