Provider Demographics
NPI:1235992215
Name:ALLEN, ROLANDE MARIE (LDO)
Entity Type:Individual
Prefix:
First Name:ROLANDE
Middle Name:MARIE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 N PINE ISLAND RD STE 105
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5234
Mailing Address - Country:US
Mailing Address - Phone:616-295-5994
Mailing Address - Fax:
Practice Address - Street 1:1860 N PINE ISLAND RD STE 105
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5234
Practice Address - Country:US
Practice Address - Phone:616-295-5994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-02
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6386156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty