Provider Demographics
NPI:1013902717
Name:ROSEMAN, KRISTEN JEAN (OD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:JEAN
Last Name:ROSEMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6451 VILLAGE LN
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-8484
Mailing Address - Country:US
Mailing Address - Phone:610-965-1800
Mailing Address - Fax:610-965-1805
Practice Address - Street 1:6451 VILLAGE LN
Practice Address - Street 2:SUITE 200
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-8484
Practice Address - Country:US
Practice Address - Phone:610-965-1800
Practice Address - Fax:610-965-1805
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-19
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001192152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3721693OtherAETNA
PAPA97028OtherVBA
PA2001148OtherKEYSTONE
PA232719844OtherBHP
PA50041756OtherBLUE CROSS
PA1587719OtherBLUE SHIELD
PA1587719OtherBLUE SHIELD
PAU98072Medicare UPIN