Provider Demographics
NPI:1669452009
Name:ROSENSWIE, SHANNON L (OD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:L
Last Name:ROSENSWIE
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 1:25 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14141-1244
Mailing Address - Country:US
Mailing Address - Phone:716-592-3322
Mailing Address - Fax:716-592-3311
Practice Address - Street 1:25 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGVILLE
Practice Address - State:NY
Practice Address - Zip Code:14141-1244
Practice Address - Country:US
Practice Address - Phone:716-592-3322
Practice Address - Fax:716-592-3311
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV-006423-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD5076Medicare ID - Type UnspecifiedUPSTATE MEDICARE