Provider Demographics
NPI:1851475057
Name:GONZALEZ, RICARDO RENE (OD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:RENE
Last Name:GONZALEZ
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:PO BOX 1137
Mailing Address - Street 2:
Mailing Address - City:ELSA
Mailing Address - State:TX
Mailing Address - Zip Code:78543-1137
Mailing Address - Country:US
Mailing Address - Phone:956-262-2020
Mailing Address - Fax:956-262-2080
Practice Address - Street 1:609 E. EDINBURG AVE.
Practice Address - Street 2:
Practice Address - City:ELSA
Practice Address - State:TX
Practice Address - Zip Code:78543-1137
Practice Address - Country:US
Practice Address - Phone:956-262-2020
Practice Address - Fax:956-262-2080
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3344T152W00000X
TX3344TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112339004Medicaid
TX00E30WMedicare ID - Type Unspecified