Amanda Danette Gonzales, O.D.
Individual provider Active NPI Optometrist · Fort Worth, TX
NPI 1356657985 · NPPES record last updated Jun 10, 2024
Key facts
- NPI
- 1356657985
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 7553TG (TX)
- Practice address
- 5336 Golden Triangle Blvd
Fort Worth, TX 76244-4406 - Phone
- (806) 577-7839
- NPI assigned
- Aug 20, 2010
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130724000778 | TX | Practitioner - Optometry |
4789825316 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7553TG | TX | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kelly J Frasier M.D., P.a. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 7553TG | TX | Yes |
Addresses
Primary practice location
5336 Golden Triangle Blvd
Fort Worth, TX 76244-4406
Mailing address
PO Box 1742
Keller, TX 76244-1742
Phone (682) 418-1156
Other names
- Amanda Danette Short
Other providers in Fort Worth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 10, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.