Provider Demographics
NPI:1518164730
Name:RODRIGUEZ, YANIRA (OD)
Entity Type:Individual
Prefix:
First Name:YANIRA
Middle Name:
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 1:11600 BANDERA RD
Mailing Address - Street 2:SUITE 102, PMB 112
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-6804
Mailing Address - Country:US
Mailing Address - Phone:787-685-8608
Mailing Address - Fax:210-497-1206
Practice Address - Street 1:22906 US HIGHWAY 281 N
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-7368
Practice Address - Country:US
Practice Address - Phone:210-495-7483
Practice Address - Fax:210-497-1206
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7024152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist