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General NPI Number Information
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NPI Number | 1174800403
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Entity Type | Individual
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Provider Name | EDNA I. BERROCAL RODRIGUEZ O.D.
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Gender | Female
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Dates
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Enumeration Date | 11/15/2011
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Last Update Date | 06/23/2014
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Provider Practice Location Address
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Address Line | 4980 EAST COLONIAL DRIVE
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City | ORLANDO
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State | FL
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Zip | 32809-4376
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Country | US
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Telephone | 407-895-6254
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Fax | 407-992-9365
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Provider Business Mailing Address
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Address Line | 4980 EAST COLONIAL DRIVE
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City | ORLANDO
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State | FL
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Zip | 32809-4376
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Country | US
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Telephone | 407-895-6254
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Fax | 407-992-9365
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 002529
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC4888
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License Number State | FL
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