Provider Demographics
NPI:1215154158
Name:ROSE, DAVID R (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:R
Last Name:ROSE
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1542A HEATHERSTONE DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-4849
Mailing Address - Country:US
Mailing Address - Phone:614-638-7673
Mailing Address - Fax:
Practice Address - Street 1:8721 DIGGES RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4403
Practice Address - Country:US
Practice Address - Phone:703-361-4161
Practice Address - Fax:703-361-4163
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0618001451152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management