Healthcare Provider Details

I. General information

NPI: 1881731842
Provider Name (Legal Business Name): ROSEANN N CIRINCIONE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ELMRIDGE CENTER DR
ROCHESTER NY
14626-3459
US

IV. Provider business mailing address

1705 COVELL RD
BROCKPORT NY
14420-9732
US

V. Phone/Fax

Practice location:
  • Phone: 585-227-2290
  • Fax:
Mailing address:
  • Phone: 585-637-0123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT-005542
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: