Provider Demographics
NPI:1427191592
Name:ROSENZWEIG, ROBERT H (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:ROSENZWEIG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 LEONARD ST NE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-1234
Mailing Address - Country:US
Mailing Address - Phone:616-456-1164
Mailing Address - Fax:616-456-9775
Practice Address - Street 1:1108 LEONARD ST NE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49503-1234
Practice Address - Country:US
Practice Address - Phone:616-456-1164
Practice Address - Fax:616-456-9775
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002374152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1014450001Medicare NSC