Active NPI
Paul G Rousseau OD PA
- Optometrist
- Melbourne, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPC2641
- Legal business name
- PAUL G ROUSSEAU OD PA
- Practice address
- 5455 Murrell Road
Suite 107
Melbourne, FL 32955-1986 - Phone
- (321) 636-1972
- Fax
- (321) 636-1507
- NPI assigned
- May 20, 2009
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Paul G Rousseau, OD
- Title
- Owner / President
- Phone
- (321) 636-1972
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPC2641 | FL | Primary |
Addresses
Primary practice location
5455 Murrell Road
Suite 107
Melbourne, FL 32955-1986
Mailing address
5455 Murrell Road
Suite 107
Melbourne, FL 32955-1986
Phone (321) 636-1972
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20396 | Other | FL | MEDICARE PTAN |
National Provider Directory
National Provider Directory- Tax ID family
- Lifetime Eyecare
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Clinic/Center
- Viera, FL
- NPI 1265762918
Locations
5455 Murrell Rd
Ste 107
Viera, FL 32955
Phone (321) 253-2020
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Vision Therapy Optometrist
- Rockledge, FL
- NPI 1427271857
-
- Optometrist
- Rockledge, FL
- NPI 1275576712
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1242777600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1336003200000",
"number": "1003041906",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5455 MURRELL ROAD",
"address_2": "SUITE 107",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329551986",
"telephone_number": "321-636-1972",
"fax_number": "321-636-1507"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5455 MURRELL ROAD",
"address_2": "SUITE 107",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329551986",
"telephone_number": "321-636-1972",
"fax_number": "321-636-1507"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PAUL G ROUSSEAU OD PA",
"organizational_subpart": "NO",
"enumeration_date": "2009-05-20",
"last_updated": "2012-05-03",
"status": "A",
"authorized_official_last_name": "ROUSSEAU",
"authorized_official_first_name": "PAUL",
"authorized_official_middle_name": "G",
"authorized_official_title_or_position": "OWNER / PRESIDENT",
"authorized_official_telephone_number": "321-636-1972",
"authorized_official_credential": "OD"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": "FL",
"license": "OPC2641",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE PTAN",
"identifier": "20396",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Melbourne, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.