Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 8808 | TX |
NPI | 1003275165 |
---|---|
Provider Name | Ricardo Rodriguez |
First Address | Irving, TX 75039-4555 |
Second Address | Irving, TX 75039-4581 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2016 |
Last Update Date | 07/03/2016 |