Provider Demographics
NPI:1235196270
Name:ROSADO MARTIN, CARLENE (OD FAAO)
Entity Type:Individual
Prefix:DR
First Name:CARLENE
Middle Name:
Last Name:ROSADO MARTIN
Suffix:
Gender:F
Credentials:OD FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2159 BARRACKS RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-4812
Mailing Address - Country:US
Mailing Address - Phone:434-977-2020
Mailing Address - Fax:
Practice Address - Street 1:2159 BARRACKS RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4812
Practice Address - Country:US
Practice Address - Phone:434-977-2020
Practice Address - Fax:434-977-4842
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001561152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAV12367Medicare UPIN
VA013503D88Medicare PIN