Healthcare Provider Details

I. General information

NPI: 1366497661
Provider Name (Legal Business Name): ROVETTA MARIE MATTIA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

735 JOHN R RD STE 150
TROY MI
48083-5859
US

IV. Provider business mailing address

7230 ORCHARD LAKE RD
WEST BLOOMFIELD MI
48322-3603
US

V. Phone/Fax

Practice location:
  • Phone: 248-577-3659
  • Fax: 248-588-9917
Mailing address:
  • Phone: 248-661-5100
  • Fax: 215-661-8816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3329
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number009972
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberI5-0000004
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1509
License Number StateNH
# 5
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-002655
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTPOP149
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberRQ004081
License Number StateMI
# 8
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004081
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: