Provider Demographics
NPI:1568890804
Name:DR. ELLIOTT ROSENGARTEN, OD, PSC
Entity Type:Organization
Organization Name:DR. ELLIOTT ROSENGARTEN, OD, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSENGARTEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:502-426-5000
Mailing Address - Street 1:2420 LIME KILN LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-3425
Mailing Address - Country:US
Mailing Address - Phone:502-426-5000
Mailing Address - Fax:502-426-2377
Practice Address - Street 1:2420 LIME KILN LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-3425
Practice Address - Country:US
Practice Address - Phone:502-426-5000
Practice Address - Fax:502-426-2377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY965DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100221010Medicaid
KY1062201Medicaid
KY1062201Medicaid
KYK052320Medicare PIN