Provider Demographics
NPI:1497740377
Name:RODRIGUEZ, MONICA M (OD)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:M
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 FM 407 E
Mailing Address - Street 2:
Mailing Address - City:BARTONBILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-9743
Mailing Address - Country:US
Mailing Address - Phone:940-455-7444
Mailing Address - Fax:940-455-7119
Practice Address - Street 1:3600 FM 407 E
Practice Address - Street 2:
Practice Address - City:BARTONBILLE
Practice Address - State:TX
Practice Address - Zip Code:76226-9743
Practice Address - Country:US
Practice Address - Phone:940-455-7444
Practice Address - Fax:940-455-7119
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5984152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU87458Medicare UPIN
TX83711EMedicare ID - Type Unspecified