Provider Demographics
NPI:1245585298
Name:PROFESSIONAL OPTOMETRIC SERVICES, PC
Entity Type:Organization
Organization Name:PROFESSIONAL OPTOMETRIC SERVICES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-625-5657
Mailing Address - Street 1:440 N ALVERNON WAY
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1958
Mailing Address - Country:US
Mailing Address - Phone:520-327-6215
Mailing Address - Fax:
Practice Address - Street 1:230 W CONTINENTAL RD STE 408
Practice Address - Street 2:
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85622-3591
Practice Address - Country:US
Practice Address - Phone:520-625-5657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-16
Last Update Date:2012-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1848152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1285719237OtherTYPE 1 NPI
AZ691957Medicaid