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Contact Information

ROSEDALE EYECARE
19460 GRAND RIVER
DETROIT, MI48223
 Phone: 313-533-4003
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
 

Eyewear Supplier

332H00000X 87 All Other Suppliers
Indicates primary specialty

NPI Profile & details for ROSEDALE EYECARE

NPI Number 1902968837
LBN Legal business name ROSEDALE EYECARE
Authorized official DERRICK MARTIN - (VP)
Entity Organization
Organization subpart 1 No
Enumeration date 12/15/2006
Last updated 09/11/2025 - About 9 months ago
Identifiers
MI License # 4901002131
MI Medicaid 4J10880
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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