Provider Demographics
NPI:1770584781
Name:ROSENWALD, PETER (OD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:ROSENWALD
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 1:23 BALSAM RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-4377
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:100 HAWLEY LN
Practice Address - Street 2:SUITE 16
Practice Address - City:TRUMBULL
Practice Address - State:CT
Practice Address - Zip Code:06611-5330
Practice Address - Country:US
Practice Address - Phone:203-378-9462
Practice Address - Fax:203-380-9823
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0744152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTT23485Medicare UPIN