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General NPI Number Information
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NPI Number | 1275715377
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Entity Type | Individual
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Provider Name | ROSALIA KREVATAS O.D.
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Gender | Female
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Dates
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Enumeration Date | 11/29/2007
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Last Update Date | 11/07/2011
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Provider Practice Location Address
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Address Line | 2251 N FEDERAL HWY NEXT TO SEARS OPTICAL
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City | POMPANO BEACH
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State | FL
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Zip | 33062-1009
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Country | US
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Telephone | 954-783-1169
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Fax | 954-781-0500
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Provider Business Mailing Address
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Address Line | 3513 ARTHUR ST
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City | HOLLYWOOD
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State | FL
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Zip | 33021-4968
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Country | US
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Telephone | 954-579-9057
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Fax | 954-781-0500
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC3878
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License Number State | FL
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