MEDICARE: MARK ELIOT ROGERS O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPC3049	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1528083862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK ELIOT ROGERS O.D.

Provider Business Mailing Address
First Line	:	7154 N UNIVERSITY DR
Second Line	:	STE103
City	:	TAMARAC
State	:	FL
Zip	:	33321-2916
Country	:	US
Telephone Number	:	954-234-4239
Fax Number	:

Provider Business Practice Location Address
First Line	:	5865 N UNIVERSITY DR
Second Line	:
City	:	TAMARAC
State	:	FL
Zip	:	33321-4617
Country	:	US
Telephone Number	:	954-234-4239
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	07/08/2007

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