Provider Demographics
NPI:1619299591
Name:ROSENTHAL, HENRY BAUM (OD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:BAUM
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:7800 E ILIFF AVE UNIT I
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-5306
Mailing Address - Country:US
Mailing Address - Phone:303-752-1234
Mailing Address - Fax:303-363-8947
Practice Address - Street 1:7800 E ILIFF AVE UNIT I
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-5306
Practice Address - Country:US
Practice Address - Phone:303-752-1234
Practice Address - Fax:303-751-1675
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1278152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COT60868Medicare UPIN