Provider Demographics
NPI:1932181104
Name:MUNOZ, RICK (OD)
Entity Type:Individual
Prefix:DR
First Name:RICK
Middle Name:
Last Name:MUNOZ
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 1:611 N TOM GREEN AVE
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4525
Mailing Address - Country:US
Mailing Address - Phone:432-332-0616
Mailing Address - Fax:432-332-6920
Practice Address - Street 1:611 N TOM GREEN AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4525
Practice Address - Country:US
Practice Address - Phone:432-332-0616
Practice Address - Fax:432-332-6920
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5634T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019118101Medicaid
TX019118101Medicaid
TX00402EMedicare ID - Type Unspecified
TX5403230001Medicare NSC
TX00402EMedicare PIN