Provider Demographics
NPI:1679318257
Name:RODRIGUEZ, ALEXI VIDAL (OD)
Entity type:Individual
Prefix:DR
First Name:ALEXI
Middle Name:VIDAL
Last Name: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 1:297 E SEMINOLE DR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-3434
Mailing Address - Country:US
Mailing Address - Phone:305-409-4809
Mailing Address - Fax:
Practice Address - Street 1:1671 US HIGHWAY 41 BYP S UNIT 105
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-1034
Practice Address - Country:US
Practice Address - Phone:941-236-9165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC6516152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist