Provider Demographics
NPI:1902193832
Name:RODRIGUEZ, NICOLAS R (OD)
Entity Type:Individual
Prefix:DR
First Name:NICOLAS
Middle Name:R
Last Name:RODRIGUEZ
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 1:17915 TEXAS LN
Mailing Address - Street 2:
Mailing Address - City:SANTA PAULA
Mailing Address - State:CA
Mailing Address - Zip Code:93060-9638
Mailing Address - Country:US
Mailing Address - Phone:805-933-1849
Mailing Address - Fax:
Practice Address - Street 1:400 E SANTA BARBARA ST STE C
Practice Address - Street 2:
Practice Address - City:SANTA PAULA
Practice Address - State:CA
Practice Address - Zip Code:93060-2675
Practice Address - Country:US
Practice Address - Phone:805-525-6603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14152152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist