Provider Demographics
NPI:1679656581
Name:ROSENBERG, IRENE (OD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:
Last Name:ROSENBERG
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 1:26 LEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WILTON
Mailing Address - State:CT
Mailing Address - Zip Code:06897-2401
Mailing Address - Country:US
Mailing Address - Phone:203-761-9212
Mailing Address - Fax:
Practice Address - Street 1:237 DANBURY RD
Practice Address - Street 2:
Practice Address - City:WILTON
Practice Address - State:CT
Practice Address - Zip Code:06897-4062
Practice Address - Country:US
Practice Address - Phone:203-761-9119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002195152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT58056Medicare UPIN