Provider Demographics
NPI:1376624163
Name:RODRIGUEZ, ALEX J (OD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:J
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2728 RIO GRANDE BLVD NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87104-3228
Mailing Address - Country:US
Mailing Address - Phone:505-363-8060
Mailing Address - Fax:505-883-9299
Practice Address - Street 1:5100 COORS BLVD SW
Practice Address - Street 2:SUITE C
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-6263
Practice Address - Country:US
Practice Address - Phone:505-899-7474
Practice Address - Fax:505-899-4845
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM493152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist