Provider Demographics
NPI:1679639793
Name:LAMALVA, ROSANNA C (OD)
Entity Type:Individual
Prefix:DR
First Name:ROSANNA
Middle Name:C
Last Name:LAMALVA
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 1:56 SEARS RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-1102
Mailing Address - Country:US
Mailing Address - Phone:617-962-3007
Mailing Address - Fax:
Practice Address - Street 1:10 CITY HALL AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-4301
Practice Address - Country:US
Practice Address - Phone:617-523-3639
Practice Address - Fax:617-523-0393
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA4181152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALAW17302Medicare ID - Type Unspecified
MAU79496Medicare UPIN