Provider Demographics
NPI:1609059161
Name:RODRIGUEZ, CYNTHIA STEPHENSON (OD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:STEPHENSON
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 1:141 WISTERIA DR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-4951
Mailing Address - Country:US
Mailing Address - Phone:407-682-2018
Mailing Address - Fax:
Practice Address - Street 1:451 E ALTAMONTE DR
Practice Address - Street 2:SUITE #1467
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4613
Practice Address - Country:US
Practice Address - Phone:407-830-6546
Practice Address - Fax:407-830-9132
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2557152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07887830Medicaid
FL20302ZMedicare PIN
FLU24551Medicare UPIN