Provider Demographics
NPI:1487716908
Name:RIVERA RODRIGUEZ, TERRY ANN (OD)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:ANN
Last Name:RIVERA RODRIGUEZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 STREET #Y-18
Mailing Address - Street 2:VILLA NUEVA
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725
Mailing Address - Country:US
Mailing Address - Phone:787-636-1835
Mailing Address - Fax:
Practice Address - Street 1:19 STREET Y-18
Practice Address - Street 2:VILLA NUEVA
Practice Address - City:CAGUAS
Practice Address - State:PR
Practice Address - Zip Code:00725
Practice Address - Country:US
Practice Address - Phone:787-636-1835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR390152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist