Provider Demographics
NPI:1386848059
Name:RODRIGUEZ, HECTOR (OPTHALMIC DISPENSERS)
Entity Type:Individual
Prefix:MR
First Name:HECTOR
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:OPTHALMIC DISPENSERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LYNDHURST
Mailing Address - State:NJ
Mailing Address - Zip Code:07071-2520
Mailing Address - Country:US
Mailing Address - Phone:201-340-4343
Mailing Address - Fax:
Practice Address - Street 1:5202 BERGENLINE AVE
Practice Address - Street 2:
Practice Address - City:WEST NEW YORK
Practice Address - State:NJ
Practice Address - Zip Code:07093-5524
Practice Address - Country:US
Practice Address - Phone:201-974-2600
Practice Address - Fax:201-974-2999
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ31TD00331700156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ3782OtherDAVIS VISION
NJ144289OtherEYEMED
NJ6734804Medicaid
NJ19034OtherSPECTERA
NJ313241OtherNVA