Provider Demographics
NPI:1679131429
Name:RODRIGUEZ-MENA MARIN, IVAN (OD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:
Last Name:RODRIGUEZ-MENA MARIN
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 1:2903 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-4305
Mailing Address - Country:US
Mailing Address - Phone:305-649-0555
Mailing Address - Fax:305-642-3460
Practice Address - Street 1:2903 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-4305
Practice Address - Country:US
Practice Address - Phone:305-649-0555
Practice Address - Fax:305-642-3460
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-05
Last Update Date:2019-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5675152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist