Provider Demographics
NPI:1861608028
Name:RGV OPTICAL IMAGES, LLC
Entity type:Organization
Organization Name:RGV OPTICAL IMAGES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:HUGO
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:956-423-2100
Mailing Address - Street 1:PO BOX 4830
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78540-4830
Mailing Address - Country:US
Mailing Address - Phone:956-423-2100
Mailing Address - Fax:956-664-1090
Practice Address - Street 1:1331 E 6TH ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6601
Practice Address - Country:US
Practice Address - Phone:956-423-4333
Practice Address - Fax:956-682-6280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6115332B00000X
TX332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193766601Medicaid
285048902OtherMEDICAID DME
TX193766602Medicaid
TX285048901Medicaid
TX285048903OtherMEDICAID CSN
TX285048903OtherMEDICAID CSN