Basic Information
| Provider Information | |||||||||
| NPI: | 1295125672 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROSENBERG EYE CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8940 N KENDALL DR | ||||||||
| Address2: | STE 703 | ||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331762148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052793400 | ||||||||
| FaxNumber: | 3052793988 | ||||||||
| Practice Location | |||||||||
| Address1: | 1708 N ROOSEVELT BLVD | ||||||||
| Address2: | |||||||||
| City: | KEY WEST | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330407299 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3052945503 | ||||||||
| FaxNumber: | 3052945509 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2015 | ||||||||
| LastUpdateDate: | 01/23/2015 | ||||||||
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| AuthorizedOfficialLastName: | ROSENBERG | ||||||||
| AuthorizedOfficialFirstName: | STANLEY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3052793400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | ME23219 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 000189200 | 05 | FL | MEDICAID |