Provider Demographics
NPI:1154419992
Name:RODRIGUEZ, CHERYL (OD OPTOMETRY DOCTOR)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:OD OPTOMETRY DOCTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:URB HEAVENLY VIEW
Mailing Address - Street 2:#26
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778
Mailing Address - Country:US
Mailing Address - Phone:787-922-5847
Mailing Address - Fax:787-738-7022
Practice Address - Street 1:BO MONTELLANO KM 55 1
Practice Address - Street 2:PLAZA CAYEY
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-738-7310
Practice Address - Fax:787-738-7022
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR619152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0057136Medicare ID - Type Unspecified