Provider Demographics
NPI:1538834106
Name:DE ROUGEMONT, ANTHONY GEORGES (OD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:GEORGES
Last Name:DE ROUGEMONT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 NE 163RD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4732
Mailing Address - Country:US
Mailing Address - Phone:954-687-5622
Mailing Address - Fax:
Practice Address - Street 1:1711 NE 163RD ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4732
Practice Address - Country:US
Practice Address - Phone:305-945-7301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-15
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5973152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist