Provider Demographics
NPI:1558477968
Name:RAYMOND R. CORONA, O.D. P.C.
Entity Type:Organization
Organization Name:RAYMOND R. CORONA, O.D. P.C.
Other - Org Name:CORONA OPTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:R
Authorized Official - Last Name:CORONA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:928-726-1100
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZWDBNLMedicare ID - Type Unspecified
AZDE0840Medicare PIN
AZ0464730001Medicare NSC