Individual
ANGELA M RODRIGUEZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
21 PARK PLACE, APPLETON, WI 54914-8872
(920) 739-4361
(920) 739-6368
Mailing address
21 PARK PLACE, APPLETON, WI 54914-8872
(920) 739-4361
(920) 739-6368
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3225-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000745140
MEDICARE-UNSPECIFIED
WI
05
—
32681900
—
WI
Enumeration date
06/29/2011
Last updated
03/26/2013
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