Individual provider Active NPI

Mariem Rodriguez, OD

  • Optometrist
  • Anasco, PR
National Provider Identifier
1447396452
Registry record updated Oct 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
507 Issued in PR
Practice address
Plaza Salcedo
Suite 104
Anasco, PR 00610
Phone
(787) 826-6484
Fax
(787) 826-0215
NPI assigned
Jan 29, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 507 PR Primary

Addresses

Primary practice location

Plaza Salcedo
Suite 104
Anasco, PR 00610

Mailing address

116 Calle 65 Infanteria
Ste 1
Anasco, PR 00610-2941
Phone (787) 826-6484

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070724000290 PR Practitioner - Optometry 0244331049 Practice locations: Anasco, PR

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
507PRMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Centro Vision Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170028800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476835200000",
    "number": "1447396452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 CALLE 65 INFANTERIA",
            "address_2": "STE 1",
            "city": "ANASCO",
            "state": "PR",
            "postal_code": "006102941",
            "telephone_number": "787-826-6484",
            "fax_number": "787-826-0215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "PLAZA SALCEDO",
            "address_2": "SUITE 104",
            "city": "ANASCO",
            "state": "PR",
            "postal_code": "00610",
            "telephone_number": "787-826-6484",
            "fax_number": "787-826-0215"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "MARIEM",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-29",
        "last_updated": "2016-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PR",
            "license": "507",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Anasco, PR

Sources for this page

Verify at the official NPI Registry.