Provider Demographics
NPI:1194000638
Name:NUNEZ RODRIGUEZ, IRIS THAMARA (OD)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:THAMARA
Last Name:NUNEZ RODRIGUEZ
Suffix:
Gender:F
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 60401
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:PR
Mailing Address - Zip Code:00690-9003
Mailing Address - Country:US
Mailing Address - Phone:787-356-8037
Mailing Address - Fax:883-516-1738
Practice Address - Street 1:2906 MATOMAS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO AGUADILLAS
Practice Address - State:PR
Practice Address - Zip Code:00690-0069
Practice Address - Country:US
Practice Address - Phone:787-356-8037
Practice Address - Fax:888-351-6173
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR687152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR038832402Medicaid