Provider Demographics
NPI:1720152291
Name:RESZELBACH, ROSALIE (OD)
Entity Type:Individual
Prefix:
First Name:ROSALIE
Middle Name:
Last Name:RESZELBACH
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 1:31 VAN WART PATH
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTER
Mailing Address - State:MA
Mailing Address - Zip Code:02459-3720
Mailing Address - Country:US
Mailing Address - Phone:617-964-8984
Mailing Address - Fax:
Practice Address - Street 1:2034 CENTRE ST
Practice Address - Street 2:
Practice Address - City:WEST ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132-3326
Practice Address - Country:US
Practice Address - Phone:617-469-8733
Practice Address - Fax:617-327-0177
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3283152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA435058Medicare ID - Type Unspecified