Provider Demographics
NPI:1023089539
Name:ROSA, LARINA RAQUEL (OD)
Entity type:Individual
Prefix:DR
First Name:LARINA
Middle Name:RAQUEL
Last Name:ROSA
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 1:1129 NORTHERN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3022
Mailing Address - Country:US
Mailing Address - Phone:516-627-5656
Mailing Address - Fax:
Practice Address - Street 1:1129 NORTHERN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3022
Practice Address - Country:US
Practice Address - Phone:516-627-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV#006944-01152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist