Provider Demographics
NPI:1649688078
Name:RODRIGUEZ, JAMIE NICOLE (OD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:NICOLE
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:404 E PARKCENTER BLVD STE 170
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83706-7564
Mailing Address - Country:US
Mailing Address - Phone:208-210-4832
Mailing Address - Fax:208-210-4833
Practice Address - Street 1:404 E PARKCENTER BLVD STE 170
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-7564
Practice Address - Country:US
Practice Address - Phone:208-210-4832
Practice Address - Fax:208-210-4833
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-29
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2825152W00000X
WA60892989152W00000X
IDODP-100527152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist