Provider Demographics
NPI:1588737977
Name:GOMEZ, JOSE ALEJANDRO (OD)
Entity type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ALEJANDRO
Last Name:GOMEZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:186 CORNWELL AVE
Mailing Address - Street 2:
Mailing Address - City:WILLISTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11596-1048
Mailing Address - Country:US
Mailing Address - Phone:516-998-0123
Mailing Address - Fax:212-569-3166
Practice Address - Street 1:7508 37TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6538
Practice Address - Country:US
Practice Address - Phone:718-476-1458
Practice Address - Fax:718-476-1462
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT6417152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA01762OtherEYEMED
NYP4065567OtherOXFORD HEALTH
NYT006417OtherMETROPLUS
NY02266351Medicaid
NY968NOtherNATIONAL OPTICAL SERVICES
NY7184761458OtherVSP
NY3101578OtherUNITED HEALTHCARE
NYP4065567OtherOXFORD HEALTH
NYG400009489Medicare PIN