Provider Demographics
NPI:1578395141
Name:TORRES, GUSTAVO ANGEL (OD)
Entity type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:ANGEL
Last Name:TORRES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7208 CIRUELOS ST
Mailing Address - Street 2:
Mailing Address - City:PALMVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:78572-1998
Mailing Address - Country:US
Mailing Address - Phone:956-360-0376
Mailing Address - Fax:
Practice Address - Street 1:7208 CIRUELOS ST
Practice Address - Street 2:
Practice Address - City:PALMVIEW
Practice Address - State:TX
Practice Address - Zip Code:78572-1998
Practice Address - Country:US
Practice Address - Phone:956-360-0376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-14
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11278152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist