Provider Demographics
NPI:1255435491
Name:RODRIGUEZ TORRES, CARLOS J (OD)
Entity type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:J
Last Name:RODRIGUEZ TORRES
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:PO BOX 990
Mailing Address - Street 2:
Mailing Address - City:MANATI
Mailing Address - State:PR
Mailing Address - Zip Code:00674-0990
Mailing Address - Country:US
Mailing Address - Phone:787-854-5151
Mailing Address - Fax:787-854-5443
Practice Address - Street 1:CALLE MARGINAL A-4
Practice Address - Street 2:URB. SAN SALVADOR
Practice Address - City:MANATI
Practice Address - State:PR
Practice Address - Zip Code:00674-0990
Practice Address - Country:US
Practice Address - Phone:787-854-5151
Practice Address - Fax:787-854-5443
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR335152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR660576683-2OtherMCS ID
PR077124OtherCRUZ AZUL
PR6740129OtherHUMANA
PR58139OtherSSS REFORMA