1861608028 NPI number — RGV OPTICAL IMAGES, LLC

Table of content: (NPI 1861608028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861608028 NPI number — RGV OPTICAL IMAGES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RGV OPTICAL IMAGES, LLC
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:
1861608028
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2016
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:
956-423-2100
Provider Business Mailing Address Fax Number:
956-664-1090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1331 E 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESLACO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78596-6601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-423-4333
Provider Business Practice Location Address Fax Number:
956-682-6280
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GONZALEZ
Authorized Official First Name:
VICTOR
Authorized Official Middle Name:
HUGO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
956-423-2100

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , 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: 332H00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 193766601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 285048902 . This is a "MEDICAID DME" identifier . This identifiers is of the category "OTHER".
  • Identifier: 193766602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 285048901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 285048903 . This is a "MEDICAID CSN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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