Provider Demographics
NPI:1386610939
Name:DIANA GONZALEZ, OD, & ASSOCIATES, PA
Entity type:Organization
Organization Name:DIANA GONZALEZ, OD, & ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:210-305-5555
Mailing Address - Street 1:21126 MARKET RDG
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4984
Mailing Address - Country:US
Mailing Address - Phone:210-305-5555
Mailing Address - Fax:210-402-5435
Practice Address - Street 1:21126 MARKET RDG
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4984
Practice Address - Country:US
Practice Address - Phone:210-305-5555
Practice Address - Fax:210-402-5435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-24
Last Update Date:2023-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5906TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81168QOtherBLUE CROSS BLUE SHIELD
TXGO1319495OtherCLARITY
TX44973OtherDAVIS VISION
TX91FEOtherBLUE CROSS BLUE SHIELD
TX18978OtherCTC/LIFERE/
TX24855OtherSPECTERA
TX451909OtherNATIONAL VISION ADMIN
TX55748OtherSAFEGUARD/SAFEHEALTH
TX13622OtherHUMANA
TX33093OtherAVESIS
TXTX5906OtherEYEMED VISION CARE
TX44973OtherDAVIS VISION
TX81168QOtherBLUE CROSS BLUE SHIELD