Provider Demographics
NPI:1144332594
Name:ROSENTHAL, CHARLES WHITE (OD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:WHITE
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2216 NW 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33311-3721
Mailing Address - Country:US
Mailing Address - Phone:954-563-2096
Mailing Address - Fax:305-933-2463
Practice Address - Street 1:19575 BISCAYNE BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-2325
Practice Address - Country:US
Practice Address - Phone:305-933-1745
Practice Address - Fax:305-933-2463
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1860152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist