Provider Demographics
NPI:1326007188
Name:RODRIGUEZ RIVERA, ADALBERTO (OD)
Entity Type:Individual
Prefix:DR
First Name:ADALBERTO
Middle Name:
Last Name:RODRIGUEZ RIVERA
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 1:208 AVE PONCE DE LEON STE P04
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00918-1001
Mailing Address - Country:US
Mailing Address - Phone:787-767-5051
Mailing Address - Fax:787-282-6597
Practice Address - Street 1:208 AVE PONCE DE LEON STE P04
Practice Address - Street 2:
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918-1001
Practice Address - Country:US
Practice Address - Phone:787-767-5051
Practice Address - Fax:787-282-6597
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR134332H00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0571890001Medicare NSC
PR54734Medicare PIN
PRT81946Medicare UPIN