Provider Demographics
NPI:1891790879
Name:ROSENTHAL, RICHARD JAY (OD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:JAY
Last Name:ROSENTHAL
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 1:792 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-2442
Mailing Address - Country:US
Mailing Address - Phone:508-588-7245
Mailing Address - Fax:508-586-6633
Practice Address - Street 1:792 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-2442
Practice Address - Country:US
Practice Address - Phone:508-588-7245
Practice Address - Fax:508-586-6633
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2315152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW20269OtherBLUE CROSS BLUE SHIELD
MA0314013Medicaid
MA150443OtherHARVARD PILGRIM HEALTH CA
TX5948162OtherAETNA
MA725456OtherTUFTS HEALTH PLAN
MA000000025343OtherBMC HEALTH NET PLAN
MA0006620OtherNEIGHBORHOOD HEALTH PLAN
TXE00046286677OtherAETNA
MAW15649OtherBLUE CROSS BLUE SHIELD
MAPR51973800001OtherCIGNA
MAW20269OtherBLUE CROSS BLUE SHIELD
MAT59150Medicare UPIN
MA4726870001Medicare NSC