MEDICARE: JAY S ROSEN 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	OP0002790	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1326032822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAY S ROSEN O.D.

Provider Business Mailing Address
First Line	:	4790 BARKLEY CIR BLDG C-103
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-7543
Country	:	US
Telephone Number	:	239-936-8686
Fax Number	:	239-936-2532

Provider Business Practice Location Address
First Line	:	4790 BARKLEY CIR BLDG C-103
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-7543
Country	:	US
Telephone Number	:	239-936-8686
Fax Number	:	239-936-2532

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

Provider Enumeration Date	:	09/12/2005
Last Update Date	:	03/24/2011

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Directions to “ JAY S ROSEN O.D.” Practice Location

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