MEDICARE: DR. BRIAN D. ROSENBLATT 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	2386	SC

General Provider Information

NPI Number	:	1306885827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN D. ROSENBLATT O.D.

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	:	7643 RIVERS AVE STE D7643
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-4073
Country	:	US
Telephone Number	:	843-797-0737
Fax Number	:	843-797-7098

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	06/20/2023

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