Provider Demographics
NPI:1669765251
Name:RAYMOND R. RENDON & ASSOCIATES
Entity type:Organization
Organization Name:RAYMOND R. RENDON & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCULARIST
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:R
Authorized Official - Last Name:RENDON
Authorized Official - Suffix:
Authorized Official - Credentials:BCO
Authorized Official - Phone:408-297-4850
Mailing Address - Street 1:2120 FOREST AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1478
Mailing Address - Country:US
Mailing Address - Phone:408-297-4850
Mailing Address - Fax:408-297-0676
Practice Address - Street 1:2120 FOREST AVE STE 2
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1478
Practice Address - Country:US
Practice Address - Phone:408-297-4850
Practice Address - Fax:408-297-0676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-16
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4744627Medicaid
CA0536440002Medicare UPIN