Provider Demographics
NPI:1093701997
Name:RODRIGUEZ, RAYMOND III (OD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:RODRIGUEZ
Suffix:III
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 1:61 STREET 2
Mailing Address - Street 2:PASEO ALTO
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926
Mailing Address - Country:US
Mailing Address - Phone:787-755-1414
Mailing Address - Fax:787-761-4141
Practice Address - Street 1:GALERIA PASEOS MALL
Practice Address - Street 2:SUITE 116
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00926
Practice Address - Country:US
Practice Address - Phone:787-755-1414
Practice Address - Fax:787-761-4141
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4377152W00000X
PR228152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist