Mario J Gonzales, OD
Optometrist in Hercules, CA. Individual provider (NPI-1).
NPI number1427014166
StatusActive
Last updated in NPPESJan 3, 2022
Details
- NPI
- 1427014166
- Entity type
- Individual (NPI-1)
- Name
- Mario J Gonzales
- Credential
- OD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Apr 21, 2006
- Last updated
- Jan 3, 2022
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PRACTITIONER - OPTOMETRY
- Can order and refer
- Part B Yes · DME Yes · Home health Yes · Power mobility No · Hospice Yes
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 152W00000X | Optometrist | 10797 | CA | Yes |
| 152W00000X | Optometrist | 473 | NM |
Practice location
1369 Sycamore AveHercules, CA 94547-5489
Phone 510-592-1630 · Fax 510-724-0202
Mailing address
1369 Sycamore AveHercules, CA 94547-5489
Phone 510-592-1630 · Fax 510-724-0202
Is something wrong?
This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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All 14 Optometrist providers in Hercules · All 349 providers in Hercules
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