Healthcare Provider Details

I. General information

NPI: 1538098199
Provider Name (Legal Business Name): YARELIS MARTINEZ RODRIGUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 CORPORATE BLVD STE 210
NORFOLK VA
23502-4965
US

IV. Provider business mailing address

PO BOX 201564
DALLAS TX
75320-1564
US

V. Phone/Fax

Practice location:
  • Phone: 757-622-2200
  • Fax: 757-961-2971
Mailing address:
  • Phone: 947-376-2948
  • Fax: 616-383-0610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number0618003652
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: