Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | VUT006194 | NY |
NPI | 1013080415 |
---|---|
Provider Name | Dr. Consuelo Elizabeth Chavez-Gomez |
First Address | Jackson Heights, NY 11372-6538 |
Second Address | Jackson Heights, NY 11372-6538 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 01/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02042368 | (05) | NY |
3101581 | UNITED HEALTHCARE (01) | NY |
52743 | DAVIS (01) | NY |
922825 | BLOCK (01) | NY |
NY6871 | EYEMED (01) | NY |
OV27627 | SPECTERA (01) | NY |
T006194 | METROPLUS (01) | NY |