Provider Demographics
NPI:1750439006
Name:GONZALEZ, SHEILA ANN (OD)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:ANN
Last Name:GONZALEZ
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:ST. 6 I-4 VERSALLES
Mailing Address - Street 2:
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00959
Mailing Address - Country:US
Mailing Address - Phone:787-740-6201
Mailing Address - Fax:787-778-1777
Practice Address - Street 1:2050 PONCE BYP
Practice Address - Street 2:STE #101 DEL CARIBE MALL
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00716-1911
Practice Address - Country:US
Practice Address - Phone:787-259-8882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR475152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist