Provider Demographics
NPI:1992310320
Name:ABREU RODRIGUEZ, ERICK CARLOS (OD)
Entity type:Individual
Prefix:
First Name:ERICK
Middle Name:CARLOS
Last Name:ABREU RODRIGUEZ
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 1:2338 NW 38TH AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-5669
Mailing Address - Country:US
Mailing Address - Phone:786-426-5556
Mailing Address - Fax:
Practice Address - Street 1:6667 W NEWBERRY RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4310
Practice Address - Country:US
Practice Address - Phone:352-332-6702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-11
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC005858152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist