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General NPI Number Information
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NPI Number | 1861915225
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Entity Type | Individual
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Provider Name | BONNIE D. ROSENBERG OD
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Gender | Female
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 09/04/2024
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Provider Practice Location Address
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Address Line | 621 S WESTERN AVE STE 214
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City | LOS ANGELES
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State | CA
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Zip | 90005-3042
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Country | US
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Telephone | 213-389-1001
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 642761
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City | LOS ANGELES
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State | CA
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Zip | 90064-8258
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Country | US
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Telephone |
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Fax |
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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 | 27OM00146800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV008859
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT35656-TLG
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 27OA00679400
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License Number State | NJ
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