Healthcare Provider Details

I. General information

NPI: 1275325060
Provider Name (Legal Business Name): LAKEWOOD RANCH RETINA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2025
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10910 NW 8TH CT
PLANTATION FL
33324-7352
US

IV. Provider business mailing address

10910 NW 8TH CT
PLANTATION FL
33324-7352
US

V. Phone/Fax

Practice location:
  • Phone: 941-312-1091
  • Fax:
Mailing address:
  • Phone: 941-312-1091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: LANDON ROHOWETZ
Title or Position: OWNER
Credential: MD
Phone: 941-312-1091