Provider Demographics
NPI:1447304712
Name:CHARLES ROSENTHAL, P.A.
Entity type:Organization
Organization Name:CHARLES ROSENTHAL, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WHITE ROSENTHAL
Authorized Official - Last Name:ROSENTHAL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-933-1745
Mailing Address - Street 1:19575 BISCAYNE BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-2325
Mailing Address - Country:US
Mailing Address - Phone:305-933-1745
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL1860152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21162AMedicare ID - Type Unspecified