Provider Demographics
NPI:1619092442
Name:RODRIGUEZ, JUANA F (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:JUANA
Middle Name:F
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 FULTON AVE
Mailing Address - Street 2:B
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-3752
Mailing Address - Country:US
Mailing Address - Phone:516-481-2020
Mailing Address - Fax:516-620-9064
Practice Address - Street 1:112 FULTON AVE
Practice Address - Street 2:B
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-3752
Practice Address - Country:US
Practice Address - Phone:516-481-2020
Practice Address - Fax:516-620-9064
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008554-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician