Provider Demographics
NPI:1114923216
Name:RODRIGUEZ, JAIME (OD)
Entity Type:Individual
Prefix:DR
First Name:JAIME
Middle Name:
Last Name:RODRIGUEZ
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:PO BOX 283
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0283
Mailing Address - Country:US
Mailing Address - Phone:787-267-7829
Mailing Address - Fax:787-267-7829
Practice Address - Street 1:550 CARR 128
Practice Address - Street 2:STE 106
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-4434
Practice Address - Country:US
Practice Address - Phone:787-267-7829
Practice Address - Fax:787-267-7829
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-23
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR524152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR7127OtherFIRST MEDICAL CARD
PR55421ROOtherTRIPLE S
PR890158OtherMMM
PR55421ROOtherTRIPLE S
PR55421Medicare ID - Type Unspecified
PR84733BMedicare ID - Type UnspecifiedGROUP
PR03320OtherAMERICAN HEALTH
PR55421ROOtherTRIPLE S
PR215112OtherPREFERRED HEALTH