MEDICARE: DR. RICK RODRIGUEZ O.D.

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	T03057	MO
2	152W00000X	Optometrist		IL

General Provider Information

NPI Number	:	1528082450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICK RODRIGUEZ O.D.

Provider Business Mailing Address
First Line	:	PO BOX 31817
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-0817
Country	:	US
Telephone Number	:	314-664-1158
Fax Number	:	314-664-0837

Provider Business Practice Location Address
First Line	:	3535 S JEFFERSON AVE
Second Line	:	SUITE S7
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-3930
Country	:	US
Telephone Number	:	314-664-1158
Fax Number	:	314-664-0837

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/09/2007

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