Organization
LEONCIO V GONZALEZ OD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEONCIO V GONZALEZ OD (OPTOMETRIST)
(305) 220-8333
Entity
Organization
Contact information
Practice address
11760 BIRD RD, SUITE 101, MIAMI, FL 33175-3582
(305) 220-8333
(305) 220-1971
Mailing address
11760 BIRD RD, SUITE 101, MIAMI, FL 33175-3582
(305) 220-8333
(305) 220-1971
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
OP 2772
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1138160001
DME
FL
05
—
620109100
—
FL
Enumeration date
12/14/2010
Last updated
09/28/2011
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