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General NPI Number Information
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NPI Number | 1609914829
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Entity Type | Organization
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Legal Business Name | RGM OPTICAL SRV INC
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Dates
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Enumeration Date | 02/01/2007
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 6079 BRANDT PIKE
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City | HUBER HEIGHTS
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State | OH
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Zip | 45424
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Country | US
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Telephone | 937-237-8669
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Fax | 937-237-9019
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Provider Business Mailing Address
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Address Line | 6079 BRANDT PIKE
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City | HUBER HEIGHTS
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State | OH
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Zip | 45424
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Country | US
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Telephone | 937-237-8669
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Fax | 937-237-9019
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Authorized Official
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Title or Position | PRESIDENT LDO
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Name | MR. REY G MALONJAO
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Credential | LICENSING DISPENSING
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Telephone | 937-237-8669
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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 | 4554
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 156F00000X
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Taxonomy Name | Technician/Technologist
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License Number | S5371
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License Number State | OH
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