Provider Demographics
NPI:1942404488
Name:ROSENBLATT, MICHELLE (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:ROSENBLATT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:MICHELLE
Other - Middle Name:ROSENBLATT
Other - Last Name:BENATAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5142 PEARLMAN WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3714
Mailing Address - Country:US
Mailing Address - Phone:858-755-5412
Mailing Address - Fax:
Practice Address - Street 1:2404 MADISON AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-2920
Practice Address - Country:US
Practice Address - Phone:619-291-3816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9039T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist