Provider Demographics
NPI:1306885827
Name:ROSENBLATT, BRIAN D (OD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:D
Last Name:ROSENBLATT
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8614 WESTWOOD CENTER DR FL 9
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2442
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:7643 RIVERS AVE STE D7643
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-4073
Practice Address - Country:US
Practice Address - Phone:843-797-0737
Practice Address - Fax:843-797-7098
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2386152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU01588Medicare UPIN
NJ602136Medicare ID - Type Unspecified