MEDICARE: LUIS F RODRIGUEZ OPTICIAN

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

General Provider Information

NPI Number	:	1144497371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUIS F RODRIGUEZ OPTICIAN

Provider Business Mailing Address
First Line	:	8828 W STATE ROAD 84
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33324-4415
Country	:	US
Telephone Number	:	954-916-8484
Fax Number	:

Provider Business Practice Location Address
First Line	:	8828 W STATE ROAD 84
Second Line	:
City	:	DAVIE
State	:	FL
Zip	:	33324-4415
Country	:	US
Telephone Number	:	954-916-8484
Fax Number	:

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

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	05/16/2008

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Directions to “ LUIS F RODRIGUEZ OPTICIAN” Practice Location

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