Provider Demographics
NPI:1437198009
Name:RODRIGUEZ, RODOLFO L (OD)
Entity Type:Individual
Prefix:
First Name:RODOLFO
Middle Name:L
Last Name:RODRIGUEZ
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 1:7922 KENNEDY BLVD
Mailing Address - Street 2:OPTOMETRIC PHYSICIAN
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-4175
Mailing Address - Country:US
Mailing Address - Phone:201-295-2020
Mailing Address - Fax:201-295-0804
Practice Address - Street 1:7922 KENNEDY BLVD
Practice Address - Street 2:OPTOMETRIC PHYSICIAN
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-4175
Practice Address - Country:US
Practice Address - Phone:201-295-2020
Practice Address - Fax:201-295-0804
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA004242152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0632300001Medicare NSC
NJ521420Medicare ID - Type Unspecified
NJT81536Medicare UPIN