Healthcare Provider Details

I. General information

NPI: 1821190315
Provider Name (Legal Business Name): ROSE GREGORY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1536 BENNING RD NE
WASHINGTON DC
20002-4516
US

IV. Provider business mailing address

1536 BENNING RD NE
WASHINGTON DC
20002-4516
US

V. Phone/Fax

Practice location:
  • Phone: 202-388-0600
  • Fax: 202-388-3643
Mailing address:
  • Phone: 202-388-0600
  • Fax: 202-388-3643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOP489
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: