Provider Demographics
NPI:1043497639
Name:DR. RONALD F. DE LA FUENTE & ASSOCIATES
Entity Type:Organization
Organization Name:DR. RONALD F. DE LA FUENTE & ASSOCIATES
Other - Org Name:CENTRAL VISION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:F
Authorized Official - Last Name:DE LA FUENTE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:214-529-1849
Mailing Address - Street 1:1145 14TH ST
Mailing Address - Street 2:2115
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-1119
Mailing Address - Country:US
Mailing Address - Phone:972-424-7236
Mailing Address - Fax:
Practice Address - Street 1:1145 14TH ST
Practice Address - Street 2:2115
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-1119
Practice Address - Country:US
Practice Address - Phone:972-424-7236
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-25
Last Update Date:2008-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5936TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty