Provider Demographics
NPI:1992895403
Name:GONCALVES, ALEXANDER F (OD)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:F
Last Name:GONCALVES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 CAPITOL AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5755
Mailing Address - Country:US
Mailing Address - Phone:916-446-0125
Mailing Address - Fax:916-446-3586
Practice Address - Street 1:2131 CAPITOL AVE
Practice Address - Street 2:SUITE 107
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5755
Practice Address - Country:US
Practice Address - Phone:916-446-0125
Practice Address - Fax:916-446-3586
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 7198 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0071980Medicaid
CA02812OtherMEDICAL EYE SERVICES
CA3954390001OtherNORIDIAN
CASD0071980Medicare ID - Type Unspecified
CASD0071980Medicaid