Healthcare Provider Details

I. General information

NPI: 1518990159
Provider Name (Legal Business Name): MARK E. ROGERS, O.D.,P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5865 N UNIVERSITY DR
TAMARAC FL
33321-4617
US

IV. Provider business mailing address

7154 N UNIVERSITY DR STE 103
TAMARAC FL
33321-2916
US

V. Phone/Fax

Practice location:
  • Phone: 954-234-4239
  • Fax:
Mailing address:
  • Phone: 954-234-4239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC3049
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License NumberOPC3049
License Number StateFL

VIII. Authorized Official

Name: MARK ELIOT ROGERS
Title or Position: PRESIDENT
Credential: O.D.
Phone: 954-234-4239