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General NPI Number Information
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NPI Number | 1700286044
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Entity Type | Individual
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Provider Name | MATTHEW RODRIGUEZ O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/22/2014
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Last Update Date | 03/20/2015
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Provider Practice Location Address
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Address Line | 366 E 4TH AVE
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City | HIALEAH
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State | FL
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Zip | 33010-4998
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Country | US
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Telephone | 305-888-9910
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Fax | 305-888-9928
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Provider Business Mailing Address
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Address Line | 2900 W CYPRESS CREEK RD SUITE 1
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City | FORT LAUDERDALE
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State | FL
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Zip | 33309-1715
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Country | US
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Telephone | 954-979-2191
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Fax |
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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 | OPC4984
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License Number State | FL
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