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General NPI Number Information
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NPI Number | 1104900307
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Entity Type | Organization
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Legal Business Name | RICARDO R. GONZALEZ, O.D., P.A.
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 03/25/2014
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Provider Practice Location Address
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Address Line | 609 E. EDINBURG AVE.
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City | ELSA
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State | TX
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Zip | 78543
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Country | US
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Telephone | 956-262-2020
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Fax | 956-262-2080
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Provider Business Mailing Address
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Address Line | PO BOX 1137
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City | ELSA
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State | TX
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Zip | 78543-1137
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Country | US
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Telephone | 956-262-2020
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Fax | 956-262-2080
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Authorized Official
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Title or Position | DIRECTOR/PRES.
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Name | DR. RICARDO RENE GONZALEZ
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Credential | O.D.
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Telephone | 956-262-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3344T
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License Number State | TX
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