Provider Demographics
NPI:1992863724
Name:T ROSE HOLDINGS, INC.
Entity Type:Organization
Organization Name:T ROSE HOLDINGS, INC.
Other - Org Name:TRAVELING OPTOMETRY, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:315-682-0215
Mailing Address - Street 1:224 HARRISON ST
Mailing Address - Street 2:SUTIE 218
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13202-3056
Mailing Address - Country:US
Mailing Address - Phone:315-295-0467
Mailing Address - Fax:315-295-1096
Practice Address - Street 1:224 HARRISON ST
Practice Address - Street 2:SUTIE 218
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13202-3056
Practice Address - Country:US
Practice Address - Phone:315-295-0467
Practice Address - Fax:315-295-1096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV 006002152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02362605Medicaid
NYBA0171Medicare PIN
NY=========Medicare UPIN
NY5458840001Medicare NSC