Healthcare Provider Details

I. General information

NPI: 1083099725
Provider Name (Legal Business Name): LETICIA ALEXANDRA ROUSSO O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9960 CENTRAL PARK BLVD N STE 450
BOCA RATON FL
33428-1760
US

IV. Provider business mailing address

1515 N FLAGLER DR STE 101
WEST PALM BEACH FL
33401-3429
US

V. Phone/Fax

Practice location:
  • Phone: 561-642-1000
  • Fax: 561-804-5463
Mailing address:
  • Phone: 561-659-1270
  • Fax: 561-804-5463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC5090
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: