Provider Demographics
NPI:1093701997
Name:RODRIGUEZ, RAYMOND III (OD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:RODRIGUEZ
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GRAND PASEO BLVD STE 116
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-6535
Mailing Address - Country:US
Mailing Address - Phone:787-755-1414
Mailing Address - Fax:787-761-4141
Practice Address - Street 1:766 CELEBRATION AVE UNIT 2203
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5480
Practice Address - Country:US
Practice Address - Phone:787-462-4141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4377152W00000X
PR228152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist