Provider Demographics
NPI:1356401384
Name:SWANSON-ROSE, ROMAYNE TERESA (OD)
Entity type:Individual
Prefix:DR
First Name:ROMAYNE
Middle Name:TERESA
Last Name:SWANSON-ROSE
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 1:612 13TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-7208
Mailing Address - Country:US
Mailing Address - Phone:805-239-1177
Mailing Address - Fax:805-239-2678
Practice Address - Street 1:612 13TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-7208
Practice Address - Country:US
Practice Address - Phone:805-239-1177
Practice Address - Fax:805-239-2678
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7404-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0074040Medicaid
CAT70194Medicare UPIN
CASD0074040Medicaid
CA410002552Medicare PIN