Provider Demographics
NPI:1518960954
Name:DE ROSIER, MICHAEL KALANI (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KALANI
Last Name:DE ROSIER
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 1:26 W H ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-7167
Mailing Address - Country:US
Mailing Address - Phone:509-276-6932
Mailing Address - Fax:509-276-1608
Practice Address - Street 1:26 W H ST
Practice Address - Street 2:SUITE A
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006-7167
Practice Address - Country:US
Practice Address - Phone:509-276-6932
Practice Address - Fax:509-276-1608
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1538152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2098804Medicaid
WA5022510001Medicare NSC
WA2098804Medicaid
WAAB22677Medicare ID - Type Unspecified