Provider Demographics
NPI:1649423450
Name:RIZAL OPTIQUE OPTOMETRY, INC
Entity Type:Organization
Organization Name:RIZAL OPTIQUE OPTOMETRY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:B
Authorized Official - Last Name:VILLEGAS
Authorized Official - Suffix:III
Authorized Official - Credentials:OD
Authorized Official - Phone:562-403-2140
Mailing Address - Street 1:12841 TOWNE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-8585
Mailing Address - Country:US
Mailing Address - Phone:562-403-2140
Mailing Address - Fax:562-403-2143
Practice Address - Street 1:12841 TOWNE CENTER DR
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-8585
Practice Address - Country:US
Practice Address - Phone:562-403-2140
Practice Address - Fax:562-403-2143
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-24
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 11011 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OP11011Medicare PIN
CAU94702Medicare UPIN