Provider Demographics
NPI:1144258146
Name:OSBORNE, OLIVE C (MD)
Entity type:Individual
Prefix:DR
First Name:OLIVE
Middle Name:C
Last Name:OSBORNE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2426 EASTCHESTER RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469-5916
Mailing Address - Country:US
Mailing Address - Phone:718-708-7142
Mailing Address - Fax:347-202-7161
Practice Address - Street 1:2426 EASTCHESTER RD
Practice Address - Street 2:SUITE 203
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-5916
Practice Address - Country:US
Practice Address - Phone:718-708-7142
Practice Address - Fax:347-202-7161
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-29
Last Update Date:2017-08-16
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Provider Licenses
StateLicense IDTaxonomies
NY206441207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG73358Medicare UPIN
NYOO096T0810Medicare PIN