1932238680 NPI number — DR. ROSA OPTOMETRY, INC.

Table of content: (NPI 1932238680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932238680 NPI number — DR. ROSA OPTOMETRY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. ROSA OPTOMETRY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1932238680
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/23/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
282 N EL CAMINO REAL
Provider Second Line Business Mailing Address:
STE F
Provider Business Mailing Address City Name:
ENCINITAS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92024-2863
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-634-1957
Provider Business Mailing Address Fax Number:
760-634-1994

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
282 N EL CAMINO REAL
Provider Second Line Business Practice Location Address:
STE F
Provider Business Practice Location Address City Name:
ENCINITAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92024-2863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-634-1957
Provider Business Practice Location Address Fax Number:
760-634-1994
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROSA
Authorized Official First Name:
RON
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
760-634-1957

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  7563T , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 48528 . This is a "SAFEGUARD DENTAL AND VISION" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 06676 . This is a "MEDICAL EYE SERVICES MESC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: CA07563 . This is a "VISION BENIFITS OF AMERICA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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