Provider Demographics
NPI:1700968666
Name:ROSENTHAL, GWENN H (OD)
Entity Type:Individual
Prefix:DR
First Name:GWENN
Middle Name:H
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:1655 OAKWOOD DR
Mailing Address - Street 2:NORTH 223
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-1020
Mailing Address - Country:US
Mailing Address - Phone:610-667-4123
Mailing Address - Fax:610-667-4123
Practice Address - Street 1:1655 OAKWOOD DR
Practice Address - Street 2:NORTH 223
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-1063
Practice Address - Country:US
Practice Address - Phone:610-667-4123
Practice Address - Fax:610-667-4123
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOEG000852152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1196270001Medicare NSC
U33460Medicare UPIN
PA073669Medicare PIN