Provider Demographics
NPI:1225148422
Name:ROSENTHAL, EDWARD STEMMLER (OD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:STEMMLER
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:NED
Other - Middle Name:STEMMLER
Other - Last Name:ROSENTHAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:20283 HACIENDA CT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33498-6602
Mailing Address - Country:US
Mailing Address - Phone:561-487-2102
Mailing Address - Fax:
Practice Address - Street 1:5478 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33073
Practice Address - Country:US
Practice Address - Phone:954-974-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0000OPC1440152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620395701Medicaid
T93865Medicare UPIN
FL620395701Medicaid