MEDICARE: MRS. DEBBY HERMOSURA 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	18002929AB	IN

General Provider Information

NPI Number	:	1851444251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBBY HERMOSURA RODRIGUEZ

Provider Business Mailing Address
First Line	:	13506 DRUMMOND ST
Second Line	:
City	:	CEDAR LAKE
State	:	IN
Zip	:	46303-8888
Country	:	US
Telephone Number	:	219-805-5052
Fax Number	:	219-374-9142

Provider Business Practice Location Address
First Line	:	9521 INDIANAPOLIS BLVD
Second Line	:
City	:	HIGHLAND
State	:	IN
Zip	:	46322-2639
Country	:	US
Telephone Number	:	219-924-6281
Fax Number	:	219-769-7362

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

Provider Enumeration Date	:	01/19/2007
Last Update Date	:	07/09/2007

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