Provider Demographics
NPI:1902860562
Name:RIDGE EYE CLINIC & OPTICAL INC
Entity Type:Organization
Organization Name:RIDGE EYE CLINIC & OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:CERDA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:956-783-5500
Mailing Address - Street 1:1313 S CAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-6227
Mailing Address - Country:US
Mailing Address - Phone:956-783-5500
Mailing Address - Fax:956-783-5660
Practice Address - Street 1:1313 S CAGE BLVD
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-6227
Practice Address - Country:US
Practice Address - Phone:956-783-5500
Practice Address - Fax:956-783-5660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019085201Medicaid
TX00036SMedicare UPIN
TX019085201Medicaid