Provider Demographics
NPI:1790872604
Name:RODRIGUEZ, ISIS (OD INC)
Entity Type:Individual
Prefix:
First Name:ISIS
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:OD INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3727 SW 8TH ST STE 103
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3158
Mailing Address - Country:US
Mailing Address - Phone:305-446-8220
Mailing Address - Fax:305-445-6903
Practice Address - Street 1:3727 SW 8TH ST STE 103
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3158
Practice Address - Country:US
Practice Address - Phone:305-446-8220
Practice Address - Fax:305-445-6903
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC004187152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL621165800Medicaid