Provider Demographics
NPI:1487973319
Name:GONZALEZ, ANDREW BALDOMERO (OPTICIAN)
Entity type:Individual
Prefix:PROF
First Name:ANDREW
Middle Name:BALDOMERO
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:OPTICIAN
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Mailing Address - Street 1:1603 CALIFORNIA AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93304-1383
Mailing Address - Country:US
Mailing Address - Phone:661-204-1985
Mailing Address - Fax:661-670-5277
Practice Address - Street 1:1603 CALIFORNIA AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-1383
Practice Address - Country:US
Practice Address - Phone:661-204-1985
Practice Address - Fax:661-670-5277
Is Sole Proprietor?:No
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CASL 6043156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician