MEDICARE: DR. ROSINA MARIE CULLINS 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
1	152W00000X	Optometrist	12360T	CA
2	152WV0400X	Vision Therapy Optometrist	12360T	CA

General Provider Information

NPI Number	:	1982639365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROSINA MARIE CULLINS O.D.

Provider Business Mailing Address
First Line	:	5175 WARING RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-2705
Country	:	US
Telephone Number	:	619-583-1000
Fax Number	:	619-229-1938

Provider Business Practice Location Address
First Line	:	5175 WARING RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-2705
Country	:	US
Telephone Number	:	619-583-1000
Fax Number	:	619-229-1938

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	06/13/2012

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