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General NPI Number Information
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NPI Number | 1205817137
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Entity Type | Individual
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Provider Name | FREDERIC ROSE OD
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Gender | Male
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Dates
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Enumeration Date | 11/08/2005
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Last Update Date | 01/30/2009
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Provider Practice Location Address
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Address Line | 72 MERRIMACK ST
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City | HAVERHILL
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State | MA
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Zip | 01830-6207
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Country | US
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Telephone | 978-374-0386
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Fax | 978-372-3631
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Provider Business Mailing Address
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Address Line | 72 MERRIMACK ST
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City | HAVERHILL
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State | MA
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Zip | 01830-6207
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Country | US
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Telephone | 978-374-0386
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Fax | 978-372-3631
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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 | MA2139
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License Number State | MA
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