MEDICARE: MADELINE ROSARIO 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	245	PR
2	152W00000X	Optometrist	4901004939	MI

General Provider Information

NPI Number	:	1487737979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE ROSARIO O.D.

Provider Business Mailing Address
First Line	:	13537 COBBLESTONE CREEK DR
Second Line	:
City	:	VAN BUREN TOWNSHIP
State	:	MI
Zip	:	48111-2034
Country	:	US
Telephone Number	:	734-757-9688
Fax Number	:

Provider Business Practice Location Address
First Line	:	30729 LYON CENTER DR E
Second Line	:
City	:	NEW HUDSON
State	:	MI
Zip	:	48165-8903
Country	:	US
Telephone Number	:	248-486-3491
Fax Number	:

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

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	05/01/2024

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