Provider Demographics
NPI:1043688229
Name:RODRIGUEZ, RACHEL
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1395 FM 156 S
Mailing Address - Street 2:SUITE 107
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-4064
Mailing Address - Country:US
Mailing Address - Phone:817-962-2500
Mailing Address - Fax:817-210-4373
Practice Address - Street 1:1395 FM 156 S
Practice Address - Street 2:SUITE 107
Practice Address - City:HASLET
Practice Address - State:TX
Practice Address - Zip Code:76052-4064
Practice Address - Country:US
Practice Address - Phone:817-962-2500
Practice Address - Fax:817-210-4373
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier