Provider Demographics
NPI:1245261692
Name:ROSE, SONIA JOSHI (OD)
Entity type:Individual
Prefix:MRS
First Name:SONIA
Middle Name:JOSHI
Last Name:ROSE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SONIA
Other - Middle Name:
Other - Last Name:JOSHI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:12100 KENNEDY LANE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407
Mailing Address - Country:US
Mailing Address - Phone:540-785-3937
Mailing Address - Fax:540-785-5498
Practice Address - Street 1:12100 KENNEDY LANE
Practice Address - Street 2:SUITE 206
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407
Practice Address - Country:US
Practice Address - Phone:540-785-3937
Practice Address - Fax:540-785-5498
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001502152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA101258324Medicaid