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General NPI Number Information
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NPI Number | 1821034042
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Entity Type | Individual
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Provider Name | IVAN STEWART ROSENTHAL OD
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Gender | Male
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Dates
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Enumeration Date | 06/22/2006
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Last Update Date | 11/24/2010
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Provider Practice Location Address
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Address Line | 23 NE 44TH ST
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City | OAKLAND PARK
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State | FL
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Zip | 33334-1437
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Country | US
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Telephone | 561-487-0818
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Fax | 561-487-9030
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Provider Business Mailing Address
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Address Line | 9858 GLADES RD STE D-2
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City | BOCA RATON
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State | FL
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Zip | 33434-3982
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Country | US
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Telephone | 561-487-0818
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Fax | 561-487-9030
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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 | OPC1248
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License Number State | FL
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