Healthcare Provider Details

I. General information

NPI: 1104900307
Provider Name (Legal Business Name): RICARDO R. GONZALEZ, O.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 03/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 E. EDINBURG AVE.
ELSA TX
78543
US

IV. Provider business mailing address

PO BOX 1137
ELSA TX
78543-1137
US

V. Phone/Fax

Practice location:
  • Phone: 956-262-2020
  • Fax: 956-262-2080
Mailing address:
  • Phone: 956-262-2020
  • Fax: 956-262-2080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3344T
License Number StateTX

VIII. Authorized Official

Name: DR. RICARDO RENE GONZALEZ
Title or Position: DIRECTOR/PRES.
Credential: O.D.
Phone: 956-262-2020