MEDICARE: DR. ANTHONY GEORGES DE ROUGEMONT OD

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	OPC5973	FL

General Provider Information

NPI Number	:	1538834106
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY GEORGES DE ROUGEMONT OD

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	:	954-687-5622
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	:

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

Provider Enumeration Date	:	08/15/2021
Last Update Date	:	10/12/2021

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