Provider Demographics
NPI:1871725036
Name:GONZALEZ-OLIVA, MELANIE P (OD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:P
Last Name:GONZALEZ-OLIVA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:P
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5430 FREDERICKSBURG RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3539
Mailing Address - Country:US
Mailing Address - Phone:210-340-1212
Mailing Address - Fax:210-525-9617
Practice Address - Street 1:5430 FREDERICKSBURG RD STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-340-1212
Practice Address - Fax:210-525-9617
Is Sole Proprietor?:No
Enumeration Date:2009-08-20
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX07489TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX208363602Medicaid
TX208363603OtherCSHCN
TX208363602Medicaid