MEDICARE: A.D.R OPTOMETRICS PA

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

General Provider Information

NPI Number	:	1528777968
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A.D.R OPTOMETRICS PA

Provider Business Mailing Address
First Line	:	1711 NE 163RD ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4732
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1711 NE 163RD ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4732
Country	:	US
Telephone Number	:	305-945-7301
Fax Number	:	305-949-0703

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ANTHONY GEORGES DE ROUGEMONT
Credential	:	O.D
Telephone Number	:	954-687-5622

Provider Enumeration Date	:	11/15/2022
Last Update Date	:	11/15/2022

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