Provider Demographics
NPI:1407103344
Name:RODRIGUES, BRIAN M (OD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:M
Last Name:RODRIGUES
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 1:57 CROTON AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-4920
Mailing Address - Country:US
Mailing Address - Phone:914-923-0300
Mailing Address - Fax:914-923-0450
Practice Address - Street 1:57 CROTON AVE STE 3
Practice Address - Street 2:
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-4920
Practice Address - Country:US
Practice Address - Phone:914-923-0300
Practice Address - Fax:914-923-0300
Is Sole Proprietor?:No
Enumeration Date:2012-08-09
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2903152W00000X, 152WV0400X
NY007907152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03548634Medicaid