Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPC2781 | FL |
NPI | 1003885161 |
---|---|
Provider Name | Alexis Rodriguez |
First Address | Miami Springs, FL 33166 |
Second Address | Gainesville, FL 32608-9608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2006 |
Last Update Date | 06/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
621044900 | (05) | FL |
U53365 | (02) |