Healthcare Provider Details

I. General information

NPI: 1679673313
Provider Name (Legal Business Name): JULIE ANNE RODMAN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 W BROWARD BLVD
FORT LAUDERDALE FL
33312-1638
US

IV. Provider business mailing address

1710 NE 197TH TER
MIAMI FL
33179-3146
US

V. Phone/Fax

Practice location:
  • Phone: 954-525-1351
  • Fax:
Mailing address:
  • Phone: 305-932-6746
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC 3383
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: