MEDICARE: CARLOS J RODRIGUEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician	D1447	NJ

General Provider Information

NPI Number	:	1053528661
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLOS J RODRIGUEZ

Provider Business Mailing Address
First Line	:	178 POOR ST
Second Line	:
City	:	HACKENSACK
State	:	NJ
Zip	:	07601-1709
Country	:	US
Telephone Number	:	201-601-8119
Fax Number	:	201-617-0556

Provider Business Practice Location Address
First Line	:	2703 BERGENLINE AVE
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-3721
Country	:	US
Telephone Number	:	201-601-8119
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	07/09/2007

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Directions to “ CARLOS J RODRIGUEZ ” Practice Location

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