Healthcare Provider Details

I. General information

NPI: 1114003902
Provider Name (Legal Business Name): LINDA SANTUCCI ROUSE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S UNIVERSITY DR NSU COLLEGE OF OPTOMETRY THE EYE INSTITUTE SUITE 1408
DAVIE FL
33328-2018
US

IV. Provider business mailing address

10712 INDIAN TRL
COOPER CITY FL
33328-5507
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-1408
  • Fax: 954-262-3217
Mailing address:
  • Phone: 954-434-5304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC2635
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: