Provider Demographics
NPI:1003010323
Name:ROSSER OPT LTD
Entity Type:Organization
Organization Name:ROSSER OPT LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROSSER
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:757-220-2020
Mailing Address - Street 1:150 STRAWBERRY PLAINS RD
Mailing Address - Street 2:STE B
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-3408
Mailing Address - Country:US
Mailing Address - Phone:757-220-2020
Mailing Address - Fax:757-220-1340
Practice Address - Street 1:150 STRAWBERRY PLAINS RD
Practice Address - Street 2:STE B
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-3408
Practice Address - Country:US
Practice Address - Phone:757-220-2020
Practice Address - Fax:757-220-1340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101000404156FX1800X, 332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0733030001Medicare NSC