Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OPC 3612 | FL |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OPC 3612 | FL |
NPI | 1194768135 |
---|---|
Provider Name | Dr. Brice Alan Roselli |
First Address | Vero Beach, FL 32960-5670 |
Second Address | Vero Beach, FL 32960-5670 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 04/01/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20015A | BCBSOFFL PROVIDER # (01) | FL |
U93720 | (02) | FL |