Healthcare Provider Details

I. General information

NPI: 1356565493
Provider Name (Legal Business Name): RODMART OPTICAL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 03/13/2023
Certification Date: 03/13/2023
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: 787-892-2879
Mailing address:
  • Phone: 787-264-3848
  • Fax: 787-892-2879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2900158
License Number StatePR
# 2
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MARIA JOSEFINA RODRIGUEZ
Title or Position: SECRETARY
Credential: O.D.
Phone: 787-644-7083