Provider Demographics
NPI:1194866566
Name:DR. ADALBERTO RODRIGUEZ
Entity Type:Organization
Organization Name:DR. ADALBERTO RODRIGUEZ
Other - Org Name:ESTUDIO OPTOMETRICO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADALBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:RODRIGUEZ RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:787-723-2253
Mailing Address - Street 1:PO BOX 13311
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00908-3311
Mailing Address - Country:US
Mailing Address - Phone:787-723-2253
Mailing Address - Fax:787-724-0163
Practice Address - Street 1:1492 AVE PONCE DE LEON
Practice Address - Street 2:CENTRO EUROPA SUITE 108
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-4012
Practice Address - Country:US
Practice Address - Phone:787-723-2253
Practice Address - Fax:787-724-0163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0571890001Medicare NSC