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NPI Code Detail

MEDICARE: KRISTEN JEAN ROSEMAN O.D.

MEDICARE:   KRISTEN JEAN ROSEMAN  O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristOEG001192PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
13721693OTHERPAAETNA
2PA97028OTHERPAVBA
32001148OTHERPAKEYSTONE
4232719844OTHERPABHP
550041756OTHERPABLUE CROSS
61587719OTHERPABLUE SHIELD

General Provider Information

NPI Number : 1013902717
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN JEAN ROSEMAN O.D.
Provider Business Mailing Address
First Line : 6451 VILLAGE LN
Second Line : SUITE 200
City : MACUNGIE
State : PA
Zip : 18062-8484
Country : US
Telephone Number : 610-965-1800
Fax Number : 610-965-1805
Provider Business Practice Location Address
First Line : 6451 VILLAGE LN
Second Line : SUITE 200
City : MACUNGIE
State : PA
Zip : 18062-8484
Country : US
Telephone Number : 610-965-1800
Fax Number : 610-965-1805
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2005
Last Update Date : 06/16/2018

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Directions to “ KRISTEN JEAN ROSEMAN O.D.” Practice Location

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