Provider Demographics
NPI:1770552143
Name:ROSENBERG, LES S (OD)
Entity type:Individual
Prefix:DR
First Name:LES
Middle Name:S
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26041 LORAIN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-2739
Mailing Address - Country:US
Mailing Address - Phone:440-777-8686
Mailing Address - Fax:440-777-8689
Practice Address - Street 1:26041 LORAIN RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-2739
Practice Address - Country:US
Practice Address - Phone:440-777-8686
Practice Address - Fax:440-777-8689
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3265152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341486219OtherANTARES
OH341486219OtherUNITED HEALTHCARE
OH341486219OtherAETNA
OH000000132612OtherANTHEM BC/BS
OH0471958Medicaid
OH341486219OtherJP FARLEY
OH341486219OtherMEDICAL MUTUAL OHIO
OH341486219OtherEMERALD HEALTH NETWORK
OH341486219OtherCOMPBENEFITS
OH341486219OtherGUARDIAN
OH341486219OtherHUMANA
OH341486219OtherCIGNA
OH341486219OtherCARESOURCE
OH341486219OtherSUMMA CARE
OH341486219OtherADVANTRA
OH580001910OtherMEDICARE RAILROAD
OH341486219OtherCARESOURCE
OH341486219OtherCOMPBENEFITS
OH341486219OtherANTARES
OH0353480001Medicare NSC