Provider Demographics
NPI:1871680298
Name:REDMOND, ROSE MARY (OD)
Entity Type:Individual
Prefix:DR
First Name:ROSE
Middle Name:MARY
Last Name:REDMOND
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ROSEMARY
Other - Middle Name:
Other - Last Name:REDMOND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:15 MARION AVENUE
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810
Mailing Address - Country:US
Mailing Address - Phone:978-749-8951
Mailing Address - Fax:
Practice Address - Street 1:4110 MYSTIC VALLEY PKWY
Practice Address - Street 2:WELLINGTON CIRCLE PLAZA
Practice Address - City:MEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02155-6931
Practice Address - Country:US
Practice Address - Phone:781-391-1195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH639152W00000X
MA3694152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U62777Medicare UPIN