Provider Demographics
NPI:1417001181
Name:RODGIN, HENRY (OD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:
Last Name:RODGIN
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 1:1623 HOLLENBECK AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94087
Mailing Address - Country:US
Mailing Address - Phone:408-773-0441
Mailing Address - Fax:408-773-0225
Practice Address - Street 1:1623 HOLLENBECK
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087
Practice Address - Country:US
Practice Address - Phone:408-773-0441
Practice Address - Fax:408-773-0225
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8121T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist