Provider Demographics
NPI:1407429426
Name:REMOTIGUE, RAFAEL (OD)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:
Last Name:REMOTIGUE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1618 E CALDWELL AVE
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-9228
Mailing Address - Country:US
Mailing Address - Phone:559-737-9690
Mailing Address - Fax:
Practice Address - Street 1:1618 E CALDWELL AVE
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93292-9228
Practice Address - Country:US
Practice Address - Phone:559-737-9690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34993TLG152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist