MEDICARE: YANIRA RODRIGUEZ O.D.

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	152W00000X	Optometrist	7024	TX

General Provider Information

NPI Number	:	1518164730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YANIRA RODRIGUEZ O.D.

Provider Business Mailing Address
First Line	:	11600 BANDERA RD
Second Line	:	SUITE 102, PMB 112
City	:	SAN ANTONIO
State	:	TX
Zip	:	78250-6804
Country	:	US
Telephone Number	:	787-685-8608
Fax Number	:	210-497-1206

Provider Business Practice Location Address
First Line	:	22906 US HIGHWAY 281 N
Second Line	:	SUITE 101
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-7368
Country	:	US
Telephone Number	:	210-495-7483
Fax Number	:	210-497-1206

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

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	03/19/2013

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