MEDICARE: MR. HECTOR RODRIGUEZ OPTHALMIC DISPENSERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	31TD00331700	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3782	OTHER	NJ	DAVIS VISION
2	144289	OTHER	NJ	EYEMED
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	19034	OTHER	NJ	SPECTERA
5	313241	OTHER	NJ	NVA

General Provider Information

NPI Number	:	1386848059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HECTOR RODRIGUEZ OPTHALMIC DISPENSERS

Provider Business Mailing Address
First Line	:	354 3RD ST
Second Line	:
City	:	LYNDHURST
State	:	NJ
Zip	:	07071-2520
Country	:	US
Telephone Number	:	201-340-4343
Fax Number	:

Provider Business Practice Location Address
First Line	:	5202 BERGENLINE AVE
Second Line	:
City	:	WEST NEW YORK
State	:	NJ
Zip	:	07093-5524
Country	:	US
Telephone Number	:	201-974-2600
Fax Number	:	201-974-2999

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	04/30/2012

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