Healthcare Provider Details

I. General information

NPI: 1326679648
Provider Name (Legal Business Name): MICHELLE DAWN JHAGROO OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2020
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

211 S FEDERAL HWY
POMPANO BEACH FL
33062-5322
US

IV. Provider business mailing address

211 S FEDERAL HWY
POMPANO BEACH FL
33062-5322
US

V. Phone/Fax

Practice location:
  • Phone: 954-786-1030
  • Fax:
Mailing address:
  • Phone: 954-786-1030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC5764
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: