Healthcare Provider Details

I. General information

NPI: 1871240382
Provider Name (Legal Business Name): RODMART OPTICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2022
Last Update Date: 03/04/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 AVE UNIV INTERAMERICANA
SAN GERMAN PR
00683-4330
US

IV. Provider business mailing address

162 AVE UNIV INTERAMERICANA
SAN GERMAN PR
00683-4330
US

V. Phone/Fax

Practice location:
  • Phone: 787-264-3848
  • Fax: 787-264-3848
Mailing address:
  • Phone: 787-264-3848
  • Fax: 787-264-3848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIA J RODRIGUEZ
Title or Position: SECRETARY
Credential: OD
Phone: 787-264-3848