Provider Demographics
NPI:1871750133
Name:GONZALEZ-BERNARD, ENRIQUE (OD)
Entity type:Individual
Prefix:
First Name:ENRIQUE
Middle Name:
Last Name:GONZALEZ-BERNARD
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 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:703-795-4020
Practice Address - Street 1:6178 OXON HILL RD STE 100
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3161
Practice Address - Country:US
Practice Address - Phone:301-839-5555
Practice Address - Fax:301-839-1867
Is Sole Proprietor?:No
Enumeration Date:2008-05-22
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002572152W00000X
VA0618002532152W00000X
MDDA 2084152WC0802X, 152WS0006X
MDTA2084152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision