Provider Demographics
NPI:1700286044
Name:RODRIGUEZ, MATTHEW (OD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
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 1:2900 W CYPRESS CREEK RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1715
Mailing Address - Country:US
Mailing Address - Phone:954-979-2191
Mailing Address - Fax:
Practice Address - Street 1:366 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4998
Practice Address - Country:US
Practice Address - Phone:305-888-9910
Practice Address - Fax:305-888-9928
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-22
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4984152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist