Provider Demographics
NPI:1518001999
Name:ROSENOW, ELDON LANG (OD)
Entity Type:Individual
Prefix:
First Name:ELDON
Middle Name:LANG
Last Name:ROSENOW
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 1:817 COFFEE RD
Mailing Address - Street 2:#D
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-4241
Mailing Address - Country:US
Mailing Address - Phone:209-524-9291
Mailing Address - Fax:209-524-6362
Practice Address - Street 1:817 COFFEE RD
Practice Address - Street 2:#D
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-4241
Practice Address - Country:US
Practice Address - Phone:209-524-9291
Practice Address - Fax:209-524-6362
Is Sole Proprietor?:No
Enumeration Date:2007-02-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5759T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMR0663903OtherDEA
CASD0057590Medicare ID - Type Unspecified
CAMR0663903OtherDEA