# MICHELLE R ROUNTREE O D P A

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770703977
- **Authorized official:** MICHELLE R ROUNTREE OD (OPTOMETRIST SOLE OWNER)
- **Authorized official phone:** (954) 885-8488

## Contact information

- **Practice address:** 10800 PINES BLVD, STE 7, PEMBROKE PINES, FL 33026
- **Practice address phone:** (954) 885-8488
- **Practice address fax:** (954) 885-4919
- **Mailing address:** 10800 PINES BLVD, STE 7, PEMBROKE PINES, FL 33026-5216
- **Mailing address phone:** (954) 885-8488
- **Mailing address fax:** (954) 885-4919

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 152W00000X | Optometrist | OPC3831 | FL | Yes |

## Other

- **Enumeration date:** 04/27/2007
- **Last updated:** 02/29/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | AF 740 | MEDICARE PTAN | FL |