Healthcare Provider Details

I. General information

NPI: 1548461866
Provider Name (Legal Business Name): ROSEMARY ANNE GONZALEZ OD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 11/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 CORAL WAY
MIAMI FL
33155-1227
US

IV. Provider business mailing address

5121 SW 162ND PL
MIAMI FL
33185-5047
US

V. Phone/Fax

Practice location:
  • Phone: 305-265-7676
  • Fax: 305-265-5276
Mailing address:
  • Phone: 312-208-0420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License NumberOPC 4027
License Number StateFL

VIII. Authorized Official

Name: ROSEMARY ANNE GONZALEZ
Title or Position: OD
Credential:
Phone: 312-208-0420