MEDICARE: DR. MELISSA GOMEZ GONZALES 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	9280TG	TX

General Provider Information

NPI Number	:	1881197374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MELISSA GOMEZ GONZALES OD

Provider Business Mailing Address
First Line	:	4118 COTT ST
Second Line	:
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78411-3119
Country	:	US
Telephone Number	:	361-728-5340
Fax Number	:

Provider Business Practice Location Address
First Line	:	1540A WILDCAT DR
Second Line	:
City	:	PORTLAND
State	:	TX
Zip	:	78374-2814
Country	:	US
Telephone Number	:	361-643-1516
Fax Number	:	361-643-7479

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

Provider Enumeration Date	:	03/12/2018
Last Update Date	:	03/12/2018

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