Provider Demographics
NPI:1548461866
Name:ROSEMARY ANNE GONZALEZ OD PA
Entity type:Organization
Organization Name:ROSEMARY ANNE GONZALEZ OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-208-0420
Mailing Address - Street 1:5121 SW 162ND PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5047
Mailing Address - Country:US
Mailing Address - Phone:312-208-0420
Mailing Address - Fax:
Practice Address - Street 1:8100 CORAL WAY
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-1227
Practice Address - Country:US
Practice Address - Phone:305-265-7676
Practice Address - Fax:305-265-5276
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4027152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty