Provider Demographics
NPI:1780666263
Name:RODRIGUEZ MAISONET, NORMA IRIS (OD)
Entity Type:Individual
Prefix:DR
First Name:NORMA
Middle Name:IRIS
Last Name:RODRIGUEZ MAISONET
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:NORMA
Other - Middle Name:IRIS
Other - Last Name:RODRIGUEZ MAISONET
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:MONACO 620
Mailing Address - Street 2:EXT EL COMANDANTE
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00982
Mailing Address - Country:US
Mailing Address - Phone:787-762-0828
Mailing Address - Fax:787-762-0828
Practice Address - Street 1:MONACO 620
Practice Address - Street 2:EXT EL COMANDANTE
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982
Practice Address - Country:US
Practice Address - Phone:787-762-0828
Practice Address - Fax:787-762-0828
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR606152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRP667OtherIMC
PR100483OtherLACRUZ AZUL
PR100483OtherLACRUZ AZUL