Provider Demographics
NPI:1891790879
Name:ROSENTHAL, RICHARD JAY (OD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAY
Last Name:ROSENTHAL
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 1:4 MERLIN ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-4444
Mailing Address - Country:US
Mailing Address - Phone:508-942-0245
Mailing Address - Fax:
Practice Address - Street 1:4 MERLIN ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-4444
Practice Address - Country:US
Practice Address - Phone:508-942-0245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2315152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000000025343OtherBMC HEALTH NET PLAN
MA04-6286677OtherUNITED HEALTH CARE
MA0314013Medicaid
CA04-6286677OtherVISION SERVICE PLAN
MA046286677OtherSENIOR WHOLE HEALTH
MA725456OtherTUFTS HEALTH PLAN
TXE00046286677OtherAETNA
MAW15649OtherBLUE CROSS BLUE SHIELD
MA0006620OtherNEIGHBORHOOD HEALTH PLAN
MA046286677OtherCOMMONWEALTH INDEMNITY PL
MA150443OtherHARVARD PILGRIM HEALTH CA
MAW20269OtherBLUE CROSS BLUE SHIELD
TX5948162OtherAETNA
MAPR51973800001OtherCIGNA