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General NPI Number Information
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NPI Number | 1740362524
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Entity Type | Organization
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Legal Business Name | HAROLD ROSE OD
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 01/12/2015
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Provider Practice Location Address
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Address Line | 2819 5TH AVE
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City | HUNTINGTON
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State | WV
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Zip | 25702-1435
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Country | US
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Telephone | 304-523-9801
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Fax | 304-522-4651
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Provider Business Mailing Address
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Address Line | 2819 5TH AVE
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City | HUNTINGTON
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State | WV
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Zip | 25702-1435
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Country | US
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Telephone | 304-523-9801
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Fax | 304-522-4651
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | HAROLD ROSE
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Credential | OD
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Telephone | 304-523-9801
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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 | 480-D
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License Number State | WV
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