1285719237 NPI number — DR. HOWARD J ROSNER O.D.

Table of content: DR. HOWARD J ROSNER O.D. (NPI 1285719237)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285719237 NPI number — DR. HOWARD J ROSNER O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSNER
Provider First Name:
HOWARD
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROSNER
Provider Other First Name:
HOWARD
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1285719237
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20251 N 75TH AVE
Provider Second Line Business Mailing Address:
APT 2038
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85308-7901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-939-1213
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
711 E BELL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85022-2684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-841-9947
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152WC0802X , with the licence number:  4901002468 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152WC0802X , with the licence number: 1848 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11814912 . This is a "CAQH" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: MI2468 . This is a "EYEMED" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 00015386 . This is a "ADVANTICA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 691957 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1285719237455555517 . This is a "AVESIS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 5330000588 . This is a "CONTROLLED SUBSTANCE LICENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1285719237 . This is a "NPI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 21760749659 . This is a "NPI TYPE 2" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: P1201A . This is a "DPA/TPA SPECIAL QUALIFICATION" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 4901002468 . This is a "OPTOMETRY DPA/TPA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 1760749659 . This is a "NPI TYPE 2" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1848 . This is a "OD LICENSE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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