Provider Demographics
NPI:1649443789
Name:ROUVIER, GIDDEL A (LDO)
Entity type:Individual
Prefix:
First Name:GIDDEL
Middle Name:A
Last Name:ROUVIER
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:816 NW 11TH ST APT 801
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-3121
Mailing Address - Country:US
Mailing Address - Phone:786-356-3461
Mailing Address - Fax:
Practice Address - Street 1:3401 N MIAMI AVE STE 114
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-3527
Practice Address - Country:US
Practice Address - Phone:305-576-0048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO 5634156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician