MEDICARE: MRS. SHERILL RODRIGUEZ VALLEY LDO

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	6376	MA

General Provider Information

NPI Number	:	1295174019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHERILL RODRIGUEZ VALLEY LDO

Provider Business Mailing Address
First Line	:	1665 HARTFORD AVE STE 4
Second Line	:
City	:	JOHNSTON
State	:	RI
Zip	:	02919-3268
Country	:	US
Telephone Number	:	866-586-4824
Fax Number	:	508-858-0607

Provider Business Practice Location Address
First Line	:	1665 HARTFORD AVE STE 4
Second Line	:
City	:	JOHNSTON
State	:	RI
Zip	:	02919-3268
Country	:	US
Telephone Number	:	866-586-4824
Fax Number	:	508-858-0607

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

Provider Enumeration Date	:	06/14/2013
Last Update Date	:	09/01/2021

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Directions to “ MRS. SHERILL RODRIGUEZ VALLEY LDO” Practice Location

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