Provider Demographics
NPI:1134190127
Name:RODIO-VIVADELLI, JILL JENNIFER (OD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:JENNIFER
Last Name:RODIO-VIVADELLI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JILL
Other - Middle Name:JENNIFER
Other - Last Name:RODIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:9701 VENTNOR AVE
Mailing Address - Street 2:
Mailing Address - City:MARGATE CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:08402-2222
Mailing Address - Country:US
Mailing Address - Phone:609-399-6102
Mailing Address - Fax:609-399-4424
Practice Address - Street 1:9701 VENTNOR AVE
Practice Address - Street 2:
Practice Address - City:MARGATE CITY
Practice Address - State:NJ
Practice Address - Zip Code:08402-2222
Practice Address - Country:US
Practice Address - Phone:609-822-4242
Practice Address - Fax:609-822-3211
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006807152W00000X
PAOEG001688152W00000X
NJ27OA00593800152WC0802X
NJ27OA00133400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJP00443901OtherRAILROAD MEDICARE
NJ0046825Medicaid
NJ085567DS4Medicare PIN
NJ0046825Medicaid