Provider Demographics
NPI:1437846227
Name:RICO, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:RICO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BROMWICH LN
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-5508
Mailing Address - Country:US
Mailing Address - Phone:419-267-2462
Mailing Address - Fax:
Practice Address - Street 1:5821 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1403
Practice Address - Country:US
Practice Address - Phone:419-536-9294
Practice Address - Fax:419-536-9340
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS5455156FX1800X
OH5455S156FX1800X
OH5455156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician