MEDICARE: DR. DAVID A ROSSELLO 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	GA 002439	GA
2	152WC0802X	Corneal and Contact Management Optometrist	GA 002439	GA
3	152W00000X	Optometrist	OPT002439	GA

General Provider Information

NPI Number	:	1558329771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID A ROSSELLO O.D.

Provider Business Mailing Address
First Line	:	3580 MASSEE LANE SUITE G
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909
Country	:	US
Telephone Number	:	762-583-6110
Fax Number	:	762-583-6101

Provider Business Practice Location Address
First Line	:	3580 MASSEE LANE SUITE G
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909
Country	:	US
Telephone Number	:	762-583-6110
Fax Number	:	762-583-6101

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

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	03/06/2019

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