=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811801053
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SIAMAK ROUINFAR LDO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2026
-----------------------------------------------------
Last Update Date | 10/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16313 NEW INDEPENDENCE PKWY
-----------------------------------------------------
City | WINTER GARDEN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34787-8113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-554-0179
-----------------------------------------------------
Fax | 407-877-9007
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5843 PLUMTREE CT
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32821-7959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 156FX1800X
-----------------------------------------------------
Taxonomy Name | Optician
-----------------------------------------------------
License Number | DO5000
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------