Provider Demographics
NPI:1184785750
Name:ROSSETTI, DAVID F (OD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:F
Last Name:ROSSETTI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22R N RAILROAD ST.
Mailing Address - Street 2:
Mailing Address - City:PALMYRA
Mailing Address - State:PA
Mailing Address - Zip Code:17078-2441
Mailing Address - Country:US
Mailing Address - Phone:717-838-9411
Mailing Address - Fax:
Practice Address - Street 1:22R N RAILROAD ST.
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:PA
Practice Address - Zip Code:17078-2441
Practice Address - Country:US
Practice Address - Phone:717-838-9411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPAOE005164T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA442580013OtherMEDICARE RAILROAD
PA442580013OtherMEDICARE RAILROAD
PA0146970001Medicare NSC
PA071265Medicare PIN