Provider Demographics
NPI:1225139942
Name:VALLEY RETINA INSTITUTE P.A.
Entity Type:Organization
Organization Name:VALLEY RETINA INSTITUTE P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
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:956-631-8875
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:956-793-8388
Mailing Address - Fax:956-265-1048
Practice Address - Street 1:1309 E RIDGE RD STE 1
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-1518
Practice Address - Country:US
Practice Address - Phone:956-631-8875
Practice Address - Fax:956-682-6280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ6115152W00000X
207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081170501Medicaid
TX081170501Medicaid
TX=========OtherTAX ID FOR VRI