MEDICARE: DR. PEDRO 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	152WP0200X	Pediatric Optometrist	4389TG	TX

General Provider Information

NPI Number	:	1972674570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PEDRO GOMEZ OD

Provider Business Mailing Address
First Line	:	6655 HILLCROFT ST
Second Line	:	SUITE 222
City	:	HOUSTON
State	:	TX
Zip	:	77081-4815
Country	:	US
Telephone Number	:	713-772-6567
Fax Number	:	713-772-8113

Provider Business Practice Location Address
First Line	:	6510 HILLCROFT ST
Second Line	:	SUITE 300
City	:	HOUSTON
State	:	TX
Zip	:	77081-4702
Country	:	US
Telephone Number	:	713-772-6567
Fax Number	:	713-772-8113

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/08/2007

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