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General NPI Number Information
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NPI Number | 1417110677
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Entity Type | Organization
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Legal Business Name | ROSEDALE VISION CENTER, L.L.C.
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Dates
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Enumeration Date | 07/08/2008
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Last Update Date | 07/30/2008
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Provider Practice Location Address
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Address Line | 3424 RAINBOW EXT
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City | KANSAS CITY
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State | KS
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Zip | 66103-2081
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Country | US
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Telephone | 913-432-3937
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Fax | 913-432-3862
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Provider Business Mailing Address
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Address Line | 3424 RAINBOW EXT
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City | KANSAS CITY
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State | KS
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Zip | 66103-2081
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Country | US
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Telephone | 913-432-3937
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Fax | 913-432-3862
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Authorized Official
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Title or Position | OWNER
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Name | DR. GERARD N. LOZADA
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Credential | O.D.
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Telephone | 913-432-3937
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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 |
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License Number State |
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