Provider Demographics
NPI:1275799223
Name:ROSENBERG, SUZANNE M (OD)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:M
Last Name:ROSENBERG
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 1:6W MILL ST 1
Mailing Address - Street 2:
Mailing Address - City:MEDFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02052-1507
Mailing Address - Country:US
Mailing Address - Phone:508-359-4164
Mailing Address - Fax:
Practice Address - Street 1:6 W MILL ST
Practice Address - Street 2:MEDFIELD EYE ASSOCIATES
Practice Address - City:MEDFIELD
Practice Address - State:MA
Practice Address - Zip Code:02052-1507
Practice Address - Country:US
Practice Address - Phone:508-359-4164
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4693152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist