Healthcare Provider Details

I. General information

NPI: 1356575815
Provider Name (Legal Business Name): RG OPTICS INTERNATIONAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 05/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10367 NW 41ST ST
DORAL FL
33178-2305
US

IV. Provider business mailing address

10367 NW 41ST ST
DORAL FL
33178-2305
US

V. Phone/Fax

Practice location:
  • Phone: 305-477-4480
  • Fax: 305-477-6838
Mailing address:
  • Phone: 305-477-4480
  • Fax: 305-477-6838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code156FC0800X
TaxonomyContact Lens Technician/Technologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: MR. CARLOS ROMERO
Title or Position: OWNER
Credential:
Phone: 305-477-4480