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NPI Code Detail

MEDICARE: THEA ROSSI OD

MEDICARE:   THEA  ROSSI  OD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometristOPT002127GA

General Provider Information

NPI Number : 1104884873
Entity Type Code : Individual
Provider Name (Legal Business Name) : THEA ROSSI OD
Provider Business Mailing Address
First Line : 8614 WESTWOOD CENTER DR FL 9
Second Line :
City : VIENNA
State : VA
Zip : 22182-2442
Country : US
Telephone Number : 703-847-8899
Fax Number : 571-223-6780
Provider Business Practice Location Address
First Line : 6490 VETERANS PKWY
Second Line :
City : COLUMBUS
State : GA
Zip : 31909-3790
Country : US
Telephone Number : 706-653-6202
Fax Number : 706-653-9204
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2006
Last Update Date : 05/14/2025

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Directions to “ THEA ROSSI OD” Practice Location

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