MEDICARE: HAROLD ROSE OD

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	480-D	WV

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	:	1740362524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAROLD ROSE OD

Provider Business Mailing Address
First Line	:	2819 5TH AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25702-1435
Country	:	US
Telephone Number	:	304-523-9801
Fax Number	:	304-522-4651

Provider Business Practice Location Address
First Line	:	2819 5TH AVE
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25702-1435
Country	:	US
Telephone Number	:	304-523-9801
Fax Number	:	304-522-4651

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	HAROLD ROSE
Credential	:	OD
Telephone Number	:	304-523-9801

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	01/12/2015

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