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General NPI Number Information
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NPI Number | 1821648502
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Entity Type | Organization
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Legal Business Name | RGV EYE CENTER LLC
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Dates
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Enumeration Date | 09/16/2019
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Last Update Date | 11/07/2019
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Provider Practice Location Address
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Address Line | 2260 LINDA AVE STE 201
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City | ODESSA
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State | TX
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Zip | 79763-2663
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Country | US
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Telephone | 432-333-3937
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Fax | 432-337-3937
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Provider Business Mailing Address
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Address Line | 2260 LINDA AVE STE 201
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City | ODESSA
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State | TX
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Zip | 79763-2663
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Country | US
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Telephone | 432-333-3937
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Fax | 432-337-3937
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Authorized Official
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Title or Position | PHYSICIAN
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Name | RUSSELL D SUBIA
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Credential | O.D.
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Telephone | 432-333-3937
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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 |
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License Number State |
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