Organization
PAUL G ROUSSEAU OD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PAUL GERARD ROUSSEAU OD (DEVELOPMENTAL OPTOMETRIST)
(321) 636-1972
Entity
Organization
Contact information
Practice address
5455 MURRELL RD STE 107, VIERA, FL 32955-6615
(321) 636-1972
(321) 636-1507
Mailing address
5455 MURRELL RD STE 107, VIERA, FL 32955-6615
(321) 636-1972
(321) 636-1507
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
OPC2641
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20396Z
MEDICARE PTAN
FL
Enumeration date
12/31/2009
Last updated
05/03/2012
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