Paul G Rousseau OD PA

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

OPC2641 Issued in FL

Legal business name

PAUL G ROUSSEAU OD PA

Practice address

5455 Murrell Rd Ste 107
Viera, FL 32955-6615

Phone

(321) 636-1972

Fax

(321) 636-1507

NPI assigned

Dec 31, 2009

Last updated

May 3, 2012By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Paul Gerard Rousseau, ODNPI 1427271857

Title

Developmental Optometrist

Phone

(321) 636-1972

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Tax ID family

Lifetime Eyecare2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Paul G Rousseau OD PA

  • Optometrist
  • Melbourne, FL
  • NPI 1003041906
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Paul G Rousseau, M.S. O.D. F.C.O.V.D

  • Vision Therapy Optometrist
  • Rockledge, FL
  • NPI 1427271857
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1262217600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336003200000",
    "number": "1265762918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5455 MURRELL RD STE 107",
            "city": "VIERA",
            "state": "FL",
            "postal_code": "329556615",
            "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 RD STE 107",
            "city": "VIERA",
            "state": "FL",
            "postal_code": "329556615",
            "telephone_number": "321-636-1972",
            "fax_number": "321-636-1507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAUL G ROUSSEAU OD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-31",
        "last_updated": "2012-05-03",
        "status": "A",
        "authorized_official_last_name": "ROUSSEAU",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "GERARD",
        "authorized_official_title_or_position": "DEVELOPMENTAL OPTOMETRIST",
        "authorized_official_telephone_number": "321-636-1972",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "FL",
            "license": "OPC2641",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "20396Z",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Orlando Vamc
• Aniela Orr, PT
• Christopher Ryan Osorio, D.M.D.
• Cassandra Elizabeth Otten, MSW
• Valerie Passabile, RDN
• Arlene Peacock, RPH
• Jennifer K Pedrick
• Rakiesha Peeples
• Ricardo Pena, M.D.
• Gordon J Penn, O.D.

• Clinic/Center in Viera, FL
• Providers in Viera, FL by specialty
• Clinic/Center in Florida

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.