Healthcare Provider Details

I. General information

NPI: 1861608028
Provider Name (Legal Business Name): RGV OPTICAL IMAGES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1331 E 6TH ST
WESLACO TX
78596-6601
US

IV. Provider business mailing address

PO BOX 4830
EDINBURG TX
78540-4830
US

V. Phone/Fax

Practice location:
  • Phone: 956-423-4333
  • Fax: 956-682-6280
Mailing address:
  • Phone: 956-423-2100
  • Fax: 956-664-1090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberJ6115
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateTX

VIII. Authorized Official

Name: DR. VICTOR HUGO GONZALEZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 956-423-2100