Provider Demographics
NPI:1114061165
Name:AGUILERA, RODOLFO E (OD)
Entity Type:Individual
Prefix:DR
First Name:RODOLFO
Middle Name:E
Last Name:AGUILERA
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 1:2374 CILANTRO DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6798
Mailing Address - Country:US
Mailing Address - Phone:407-240-1175
Mailing Address - Fax:
Practice Address - Street 1:8101 S JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9021
Practice Address - Country:US
Practice Address - Phone:407-226-0549
Practice Address - Fax:407-354-2465
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2005152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT84231Medicare UPIN
FL19185Medicare ID - Type Unspecified