Provider Demographics
NPI:1942461629
Name:GOERGES, RICKEY EARL (OPTICIAN)
Entity type:Individual
Prefix:MR
First Name:RICKEY
Middle Name:EARL
Last Name:GOERGES
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7826 LOUIS PASTEUR DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3474
Mailing Address - Country:US
Mailing Address - Phone:210-494-4009
Mailing Address - Fax:210-494-9838
Practice Address - Street 1:7826 LOUIS PASTEUR DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3474
Practice Address - Country:US
Practice Address - Phone:210-494-4009
Practice Address - Fax:210-494-9838
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0965000001Medicare UPIN