Provider Demographics
NPI:1134314933
Name:LAUREN R ROSECAN MDPA
Entity Type:Organization
Organization Name:LAUREN R ROSECAN MDPA
Other - Org Name:RETINA INSTITUTE OF FLORIDA DBA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:R
Authorized Official - Last Name:ROSECAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-832-4411
Mailing Address - Street 1:901 N FLAGLER DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3713
Mailing Address - Country:US
Mailing Address - Phone:561-832-4411
Mailing Address - Fax:
Practice Address - Street 1:901 N FLAGLER DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3713
Practice Address - Country:US
Practice Address - Phone:561-832-4411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50469174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3068Medicare PIN