MEDICARE: DR. BRICE ALAN ROSELLI O.D.

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
1	152W00000X	Optometrist	OPC 3612	FL
2	152WC0802X	Corneal and Contact Management Optometrist	OPC 3612	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	20015A	OTHER	FL	BCBSOFFL PROVIDER #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194768135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRICE ALAN ROSELLI O.D.

Provider Business Mailing Address
First Line	:	333 17TH ST
Second Line	:	SUITE G
City	:	VERO BEACH
State	:	FL
Zip	:	32960-5670
Country	:	US
Telephone Number	:	772-978-0845
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 17TH ST
Second Line	:	SUITE G
City	:	VERO BEACH
State	:	FL
Zip	:	32960-5670
Country	:	US
Telephone Number	:	772-978-0845
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	01/04/2010

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