MEDICARE: PROFESSIONAL OPTOMETRIC SERVICES, PC

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	1848	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1285719237	OTHER	AZ	TYPE 1 NPI
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245585298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROFESSIONAL OPTOMETRIC SERVICES, PC

Provider Business Mailing Address
First Line	:	440 N ALVERNON WAY
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-1958
Country	:	US
Telephone Number	:	520-327-6215
Fax Number	:

Provider Business Practice Location Address
First Line	:	230 W CONTINENTAL RD STE 408
Second Line	:
City	:	GREEN VALLEY
State	:	AZ
Zip	:	85622-3591
Country	:	US
Telephone Number	:	520-625-5657
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. HOWARD ROSNER
Credential	:
Telephone Number	:	520-625-5657

Provider Enumeration Date	:	07/16/2012
Last Update Date	:	07/16/2012

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