Provider Demographics
NPI:1730062019
Name:RODRIGUEZ, LARISSA JANELLE (OD)
Entity type:Individual
Prefix:DR
First Name:LARISSA
Middle Name:JANELLE
Last Name: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 1:17261 SMYERS LN STE 100
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-2496
Mailing Address - Country:US
Mailing Address - Phone:512-501-2100
Mailing Address - Fax:
Practice Address - Street 1:17261 SMYERS LN STE 100
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-2496
Practice Address - Country:US
Practice Address - Phone:512-501-2100
Practice Address - Fax:512-827-2074
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-26
Last Update Date:2025-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11501TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist