Individual
NICHOLAS WILLIAM GONZALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1906 FAIRVIEW AVE STE 100, CALDWELL, ID 83605-5433
(208) 459-2020
Mailing address
1906 FAIRVIEW AVE STE 100, CALDWELL, ID 83605-5433
(208) 459-2020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-100620
ID
Other
Enumeration date
05/08/2023
Last updated
07/19/2023
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