Provider Demographics
NPI:1285018721
Name:GOMEZ, MARISOL NABILA (OD)
Entity type:Individual
Prefix:DR
First Name:MARISOL
Middle Name:NABILA
Last Name:GOMEZ
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:901 MOPAC EXPRESSWAY SOUTH
Mailing Address - Street 2:BUILDING 4, SUITE 350
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746
Mailing Address - Country:US
Mailing Address - Phone:512-347-0255
Mailing Address - Fax:512-347-0785
Practice Address - Street 1:901 MOPAC EXPRESSWAY SOUTH
Practice Address - Street 2:BUILDING 4, SUITE 350
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:512-347-0255
Practice Address - Fax:512-347-0785
Is Sole Proprietor?:No
Enumeration Date:2015-07-15
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLOPC 5079152W00000X
TX9030152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist