Provider Demographics
NPI:1710290143
Name:ROSENBERG, ELIZABETH E (OD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:E
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 1:503 N MCCADDEN PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-1027
Mailing Address - Country:US
Mailing Address - Phone:323-378-5775
Mailing Address - Fax:
Practice Address - Street 1:503 N MCCADDEN PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-1027
Practice Address - Country:US
Practice Address - Phone:323-378-5775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 13891152W00000X
NYTUV007465152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist