Healthcare Provider Details

I. General information

NPI: 1790361822
Provider Name (Legal Business Name): RGV OPTICAL IMAGES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2021
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 E HILLSIDE RD # 1
LAREDO TX
78041-3287
US

IV. Provider business mailing address

PO BOX 4830
EDINBURG TX
78540-4830
US

V. Phone/Fax

Practice location:
  • Phone: 956-401-6615
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: SANDRA CATHERINE GONZALEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 956-631-8875