Healthcare Provider Details

I. General information

NPI: 1417264995
Provider Name (Legal Business Name): ROSALYN LUSHAWN COLEMAN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2010
Last Update Date: 09/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 S UNIVERSITY DR TERRY BUILDING SUITE 1408
DAVIE FL
33328-2018
US

IV. Provider business mailing address

1385 NW 80TH WAY
PLANTATION FL
33322-5770
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-1402
  • Fax: 954-262-1818
Mailing address:
  • Phone: 678-778-4827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC4513
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: