Provider Demographics
NPI:1225012479
Name:ROLF, MIRIAM MICHELLE (OD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:MICHELLE
Last Name:ROLF
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 EXECTIVE DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553
Mailing Address - Country:US
Mailing Address - Phone:845-562-0138
Mailing Address - Fax:845-562-0147
Practice Address - Street 1:140 EXECUTIVE DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553
Practice Address - Country:US
Practice Address - Phone:845-562-0138
Practice Address - Fax:845-562-0147
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0056681152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U59099Medicare UPIN
C05691Medicare ID - Type Unspecified