Healthcare Provider Details

I. General information

NPI: 1497499875
Provider Name (Legal Business Name): ANDREW ROUSE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2022
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NW 17TH ST
MIAMI FL
33136-1134
US

IV. Provider business mailing address

PO BOX 84
HAGAMAN NY
12086-0084
US

V. Phone/Fax

Practice location:
  • Phone: 305-326-6170
  • Fax:
Mailing address:
  • Phone: 518-956-1733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC6115
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: