Healthcare Provider Details

I. General information

NPI: 1013902717
Provider Name (Legal Business Name): KRISTEN JEAN ROSEMAN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6451 VILLAGE LN SUITE 200
MACUNGIE PA
18062-8484
US

IV. Provider business mailing address

6451 VILLAGE LN SUITE 200
MACUNGIE PA
18062-8484
US

V. Phone/Fax

Practice location:
  • Phone: 610-965-1800
  • Fax: 610-965-1805
Mailing address:
  • Phone: 610-965-1800
  • Fax: 610-965-1805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG001192
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: