Provider Demographics
NPI:1902813470
Name:VILLEGAS, RAMON BARACHINA III (OD)
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:BARACHINA
Last Name:VILLEGAS
Suffix:III
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 1:12455 CEDARCREEK LN
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2028
Mailing Address - Country:US
Mailing Address - Phone:562-567-7646
Mailing Address - Fax:
Practice Address - Street 1:19151 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-7104
Practice Address - Country:US
Practice Address - Phone:562-567-7646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 11011 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist