Provider Demographics
NPI:1366558488
Name:FRASCO, ROSEMARY (OD)
Entity type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:
Last Name:FRASCO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 FRANKLIN TPKE
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-1913
Mailing Address - Country:US
Mailing Address - Phone:201-444-7770
Mailing Address - Fax:201-445-2570
Practice Address - Street 1:625 FRANKLIN TPKE
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:201-444-7770
Practice Address - Fax:201-445-2570
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ0A5749152W00000X
FL0PC3646152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
075505OtherMEDICARE GROUP
0755225BQMedicare ID - Type Unspecified
075505OtherMEDICARE GROUP