Provider Demographics
NPI:1912033168
Name:ESPINOSA, RICARDO (OD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:
Last Name:ESPINOSA
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 1:4001 HALLMARK PKWY
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-1876
Mailing Address - Country:US
Mailing Address - Phone:909-887-1881
Mailing Address - Fax:909-887-8557
Practice Address - Street 1:4001 HALLMARK PKWY
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-1876
Practice Address - Country:US
Practice Address - Phone:909-887-1881
Practice Address - Fax:909-887-8557
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4863T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADX117AMedicare PIN
CAOP4863Medicare UPIN