Provider Demographics
NPI:1386837904
Name:OPTICAL REFLECTIONS PLLC
Entity type:Organization
Organization Name:OPTICAL REFLECTIONS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLANDO
Authorized Official - Middle Name:R
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:956-968-3302
Mailing Address - Street 1:1506 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6606
Mailing Address - Country:US
Mailing Address - Phone:956-968-3302
Mailing Address - Fax:956-968-4403
Practice Address - Street 1:1506 E 6TH ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6606
Practice Address - Country:US
Practice Address - Phone:956-968-3302
Practice Address - Fax:956-968-4403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2753TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112431502Medicaid
TX1386837904OtherNPI GROUP
TX112431501Medicaid
TX112431502Medicaid
TX00353ZMedicare PIN
TX8F0915Medicare PIN