Healthcare Provider Details

I. General information

NPI: 1205380862
Provider Name (Legal Business Name): RGV OPTICAL IMAGES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/11/2016
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E EXPRESSWAY 83 UNIT 3
LA JOYA TX
78560-8301
US

IV. Provider business mailing address

PO BOX 4830
EDINBURG TX
78540-4830
US

V. Phone/Fax

Practice location:
  • Phone: 956-598-6130
  • Fax: 956-682-6280
Mailing address:
  • Phone: 956-631-8875
  • Fax: 956-682-6280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberJ6115
License Number StateTX

VIII. Authorized Official

Name: VICTOR GONZALEZ
Title or Position: OWNER
Credential: MD
Phone: 956-631-8875