Provider Demographics
NPI:1871027607
Name:OSMAN, ROBLE (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBLE
Middle Name:
Last Name:OSMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 23RD AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11105-2408
Mailing Address - Country:US
Mailing Address - Phone:718-626-9400
Mailing Address - Fax:
Practice Address - Street 1:3117 23RD AVE STE 2
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11105-2408
Practice Address - Country:US
Practice Address - Phone:718-626-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008558152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist