Provider Demographics
NPI:1912122268
Name:GOMES, ANA MARIE (OD)
Entity type:Individual
Prefix:DR
First Name:ANA MARIE
Middle Name:
Last Name:GOMES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-7809
Mailing Address - Country:US
Mailing Address - Phone:203-874-1661
Mailing Address - Fax:
Practice Address - Street 1:1718 BOSTON POST RD
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-2718
Practice Address - Country:US
Practice Address - Phone:203-882-8105
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2288152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT090002288CT10OtherANTHEM
CT090002288CT10OtherANTHEM