Provider Demographics
NPI:1831253046
Name:RODRIGUEZ, NIEVES (DO)
Entity type:Individual
Prefix:
First Name:NIEVES
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:OPTICA
Other - Middle Name:
Other - Last Name:ASHFORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:30 CALLE WASHINGTON
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00907-1589
Mailing Address - Country:US
Mailing Address - Phone:787-722-0215
Mailing Address - Fax:787-723-8783
Practice Address - Street 1:30 CALLE WASHINGTON
Practice Address - Street 2:SUITE 5
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00907-1589
Practice Address - Country:US
Practice Address - Phone:787-722-0215
Practice Address - Fax:787-723-8783
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR43156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician