Provider Demographics
NPI:1851444251
Name:RODRIGUEZ, DEBBY HERMOSURA
Entity Type:Individual
Prefix:MRS
First Name:DEBBY
Middle Name:HERMOSURA
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:DEBBY
Other - Middle Name:N
Other - Last Name:HERMOSURA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:13506 DRUMMOND ST
Mailing Address - Street 2:
Mailing Address - City:CEDAR LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46303-8888
Mailing Address - Country:US
Mailing Address - Phone:219-805-5052
Mailing Address - Fax:219-374-9142
Practice Address - Street 1:9521 INDIANAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:IN
Practice Address - Zip Code:46322-2639
Practice Address - Country:US
Practice Address - Phone:219-924-6281
Practice Address - Fax:219-769-7362
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002929AB152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist