Provider Demographics
NPI:1427372069
Name:GONZALEZ-LEBRON, RICARDO (OD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:
Last Name:GONZALEZ-LEBRON
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 1:30 URB TERRA DEL VALLE
Mailing Address - Street 2:
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736-3245
Mailing Address - Country:UM
Mailing Address - Phone:787-944-9525
Mailing Address - Fax:
Practice Address - Street 1:2 PORTOFINO PLAZA
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:PR
Practice Address - Zip Code:00751
Practice Address - Country:UM
Practice Address - Phone:787-944-9525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-25
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR677152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist