Provider Demographics
NPI:1588095319
Name:ROSADO GONZALEZ, BRENDA E (OD, MBA)
Entity type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:E
Last Name:ROSADO GONZALEZ
Suffix:
Gender:F
Credentials:OD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1937 HOMER RD
Mailing Address - Street 2:
Mailing Address - City:COMMERCE
Mailing Address - State:GA
Mailing Address - Zip Code:30529-1254
Mailing Address - Country:US
Mailing Address - Phone:706-335-7335
Mailing Address - Fax:
Practice Address - Street 1:1937 HOMER RD
Practice Address - Street 2:
Practice Address - City:COMMERCE
Practice Address - State:GA
Practice Address - Zip Code:30529-1254
Practice Address - Country:US
Practice Address - Phone:706-335-7335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-04
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003315152W00000X
FLOPC5147152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist