Provider Demographics
NPI:1134109309
Name:RODITIS, VASILIOS (OD)
Entity Type:Individual
Prefix:DR
First Name:VASILIOS
Middle Name:
Last Name:RODITIS
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 1:2371 32ND ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2415
Mailing Address - Country:US
Mailing Address - Phone:718-790-8660
Mailing Address - Fax:
Practice Address - Street 1:501 W 113TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-8073
Practice Address - Country:US
Practice Address - Phone:212-662-0399
Practice Address - Fax:212-662-0259
Is Sole Proprietor?:No
Enumeration Date:2006-01-21
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV 006672152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist