Active NPI
Kelsey Beth Roquet, OD
- Optometrist
- Mount Dora, FL
National Provider Identifier
1467142190
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 11111
- Practice address
- 17560 US Highway 441
Mount Dora, FL 32757-6711 - Phone
- (352) 744-7002
- Fax
- (352) 735-3233
- NPI assigned
- May 8, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 11111 | FL | Primary |
Addresses
Primary practice location
17560 US Highway 441
Mount Dora, FL 32757-6711
Mailing address
17560 US Highway 441
Mount Dora, FL 32757-6711
Phone (352) 744-7002
Other practice location 1
17556 SE 109th Terrace Rd
Summerfield, FL 34491-6907
Phone (352) 347-2100
Other practice location 2
5743 Williamsburg Ln
Wildwood, FL 34785-8129
Phone (352) 744-7002
Other practice location 3
600 N 14th St
Leesburg, FL 34748-4204
Phone (352) 787-5900
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11111 | FL | MD | Ophthalmology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683504000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683504000000",
"number": "1467142190",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17560 US HIGHWAY 441",
"city": "MOUNT DORA",
"state": "FL",
"postal_code": "327576711",
"telephone_number": "352-744-7002"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17560 US HIGHWAY 441",
"city": "MOUNT DORA",
"state": "FL",
"postal_code": "327576711",
"telephone_number": "352-744-7002",
"fax_number": "352-735-3233"
}
],
"practiceLocations": [
{
"address_1": "17556 SE 109th Terrace Rd",
"address_purpose": "LOCATION",
"city": "Summerfield",
"state": "FL",
"postal_code": "344916907",
"country_code": "US",
"telephone_number": "352-347-2100",
"fax_number": "352-735-3233",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "5743 Williamsburg Ln",
"address_purpose": "LOCATION",
"city": "Wildwood",
"state": "FL",
"postal_code": "347858129",
"country_code": "US",
"telephone_number": "352-744-7002",
"fax_number": "352-735-3233",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "600 N 14th St",
"address_purpose": "LOCATION",
"city": "Leesburg",
"state": "FL",
"postal_code": "347484204",
"country_code": "US",
"telephone_number": "352-787-5900",
"fax_number": "352-735-3233",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ROQUET",
"first_name": "KELSEY",
"middle_name": "BETH",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-05-08",
"last_updated": "2023-05-08",
"certification_date": "2023-05-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "FL",
"license": "11111",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Dora, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.