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General NPI Number Information
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NPI Number | 1083818736
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Entity Type | Individual
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Provider Name | ROBERT ROSEN O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/14/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5385 W CENTINELA AVE
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City | LOS ANGELES
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State | CA
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Zip | 90045-2003
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Country | US
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Telephone | 310-670-7422
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Fax |
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Provider Business Mailing Address
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Address Line | 2398 VIA MARIPOSA W 2A
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City | LAGUNA WOODS
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State | CA
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Zip | 92637-2009
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Country | US
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Telephone | 949-855-9512
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4299T
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License Number State | CA
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