Provider Demographics
NPI:1316771207
Name:BATAC, RODNELL STEPHEN GONZALES (OD)
Entity type:Individual
Prefix:
First Name:RODNELL STEPHEN
Middle Name:GONZALES
Last Name:BATAC
Suffix:
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 1:2351 ERWIN ROAD DUMC BOX 3802
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27710-4113
Mailing Address - Country:US
Mailing Address - Phone:702-353-8183
Mailing Address - Fax:
Practice Address - Street 1:2351 ERWIN RD DUMC BOX 3802
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27710-4699
Practice Address - Country:US
Practice Address - Phone:919-681-3937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-31
Last Update Date:2024-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2803152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty