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General NPI Number Information
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NPI Number | 1194084871
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Entity Type | Individual
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Provider Name | RONALD MICHAEL ROSA O.D
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Gender | Male
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Dates
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Enumeration Date | 05/15/2012
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Last Update Date | 05/15/2012
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Provider Practice Location Address
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Address Line | 282 N EL CAMINO REAL STE F
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City | ENCINITAS
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State | CA
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Zip | 92024-2863
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Country | US
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Telephone | 760-634-1957
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Fax | 760-634-1994
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Provider Business Mailing Address
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Address Line | 282-F NORTH EL CAMINO REAL
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City | ENICNITAS
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State | CA
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Zip | 92024
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Country | US
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Telephone | 760-634-1957
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Fax | 760-634-1994
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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 | 7563
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License Number State | CA
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