1225139942 NPI number — VALLEY RETINA INSTITUTE P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225139942 NPI number — VALLEY RETINA INSTITUTE P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALLEY RETINA INSTITUTE P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225139942
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4830
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EDINBURG
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78540-4830
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-793-8388
Provider Business Mailing Address Fax Number:
956-265-1048

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1309 E RIDGE RD STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78503-1518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-631-8875
Provider Business Practice Location Address Fax Number:
956-682-6280
Provider Enumeration Date:
09/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
HUGO
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
956-631-8875

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  J6115 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 081170501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com