Individual provider Active NPI

Angela M Rodriguez, O.D.

  • Optometrist
  • Appleton, WI
National Provider Identifier
1770870602
Registry record updated Mar 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3225-035 Issued in WI
Practice address
21 Park Place
Appleton, WI 54914-8872
Phone
(920) 739-4361
Fax
(920) 739-6368
NPI assigned
Jun 29, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3225-035 WI Primary

Addresses

Primary practice location

21 Park Place
Appleton, WI 54914-8872

Mailing address

21 Park Place
Appleton, WI 54914-8872
Phone (920) 739-4361

Other identifiers 2

IdentifierTypeStateIssuer
000745140OtherWIMEDICARE-UNSPECIFIED
32681900MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20110902000523 WI Practitioner - Optometry 1759551518 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Illinois College of Optometry at Chicago, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Valley Eye AssociatesGroup PAC ID 5395633580, 25 clinicians

Practice addresses (Care Compare)

2500 E Capitol Dr
Suite 3500
Appleton, WI 54911-8735
Phone (920) 358-1820

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
3225-035WIMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Eye Associates Optometrist CurrentSince Sep 1, 2011 Accepting new patients
Park Place Optical, LTD Past Accepting new patients

Locations

2500 E Capitol Dr
Ste 3500
Appleton, WI 54911
Phone (920) 358-1820

21 Park Pl
Appleton, WI 54914
Phone (920) 739-4361

2100 S Kensington Dr
Ste 5
Appleton, WI 54915
Phone (920) 731-1711

Interoperability endpoints

  • Direct secure messaging: arodriguez32837@direct.thedacare.org

Organizations & group practices 2

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": "1309305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364256000000",
    "number": "1770870602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 PARK PLACE",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549148872",
            "telephone_number": "920-739-4361",
            "fax_number": "920-739-6368"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 PARK PLACE",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549148872",
            "telephone_number": "920-739-4361",
            "fax_number": "920-739-6368"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODRIGUEZ",
        "first_name": "ANGELA",
        "middle_name": "M",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-29",
        "last_updated": "2013-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3225-035",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE-UNSPECIFIED",
            "identifier": "000745140",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "32681900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.