Provider Demographics
NPI:1962613737
Name:FREDERIC ROSE, OD
Entity type:Organization
Organization Name:FREDERIC ROSE, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR.
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:978-374-0386
Mailing Address - Street 1:72 MERRIMACK ST
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-6207
Mailing Address - Country:US
Mailing Address - Phone:978-374-0386
Mailing Address - Fax:978-372-3631
Practice Address - Street 1:72 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-6207
Practice Address - Country:US
Practice Address - Phone:978-374-0386
Practice Address - Fax:978-372-3631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA2139152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2200374OtherUNITED HEALTHCARE
MA1205817137OtherBLUE CROSS BLUE SHIELD
MA1962613737OtherMEDICARE
MA0396516Medicaid
MA151464OtherHARVARD PILGRIM HEALTHCAR
MA507326OtherAETNA
MA705074OtherTUFTS
MA1205817137OtherBLUE CROSS BLUE SHIELD
MA0396516Medicaid