MEDICARE: DR. ADALBERTO 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	152W00000X	Optometrist
2	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1194866566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. ADALBERTO RODRIGUEZ

Provider Business Mailing Address
First Line	:	PO BOX 13311
Second Line	:
City	:	SAN JUAN
State	:	PR
Zip	:	00908-3311
Country	:	US
Telephone Number	:	787-723-2253
Fax Number	:	787-724-0163

Provider Business Practice Location Address
First Line	:	1492 AVE PONCE DE LEON
Second Line	:	CENTRO EUROPA SUITE 108
City	:	SAN JUAN
State	:	PR
Zip	:	00907-4012
Country	:	US
Telephone Number	:	787-723-2253
Fax Number	:	787-724-0163

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ADALBERTO RODRIGUEZ RIVERA
Credential	:	OD
Telephone Number	:	787-723-2253

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	11/03/2008

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Directions to “DR. ADALBERTO RODRIGUEZ ” Practice Location

Language	Start Address	Practice Location

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