Provider Demographics
NPI:1316060387
Name:ROSENBERG, ROBERT (OD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:ROSENBERG
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 1:16414 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-3043
Mailing Address - Country:US
Mailing Address - Phone:562-947-0391
Mailing Address - Fax:562-947-0871
Practice Address - Street 1:16414 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-3043
Practice Address - Country:US
Practice Address - Phone:562-947-0391
Practice Address - Fax:562-947-0871
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 4201152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist