Healthcare Provider Details

I. General information

NPI: 1013905488
Provider Name (Legal Business Name): PETER ROSENBERG O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 12/07/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3415 W GLENDALE AVE BUILDING B, SUITE 11
PHOENIX AZ
85051-8386
US

IV. Provider business mailing address

220 N MCKEMY AVE
CHANDLER AZ
85226-2654
US

V. Phone/Fax

Practice location:
  • Phone: 602-973-5868
  • Fax: 602-973-6076
Mailing address:
  • Phone: 480-961-1865
  • Fax: 480-961-4605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number874
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: