Provider Demographics
NPI:1508970690
Name:CORONA, RAYMOND R (OD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:R
Last Name:CORONA
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 1:2149 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6136
Mailing Address - Country:US
Mailing Address - Phone:928-726-1100
Mailing Address - Fax:928-341-0881
Practice Address - Street 1:2149 W 24TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6136
Practice Address - Country:US
Practice Address - Phone:928-726-1100
Practice Address - Fax:928-341-0881
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ43152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ410008174Medicare PIN
ZWDBNL01Medicare ID - Type Unspecified
T41514Medicare UPIN