Individual provider Active NPI

Alan Marc Rosenberg, O.D.

  • Optometrist
  • North Wales, PA
National Provider Identifier
1174575740
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
5554-T Issued in PA
Practice address
26 Airport SQ
North Wales, PA 19454-1419
Phone
(215) 362-1177
Fax
(215) 362-7026
NPI assigned
May 16, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 5554-T PA Primary

Addresses

Primary practice location

26 Airport SQ
North Wales, PA 19454-1419

Mailing address

26 Airport SQ
North Wales, PA 19454-1419
Phone (215) 362-1177

Other identifiers 3

IdentifierTypeStateIssuer
4358124OtherPAAETNA
1457400OtherPABCBS/PC
2146183000OtherPAKEYSTONE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100913000822 PA Practitioner - Optometry 4880719962 Reassigns benefits to 1 organization
Practice locations: North Wales, PA

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5554-TPAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Dr. Alan M. Rosenberg Optometrist PastSince Jul 1, 2010 Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1174575740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "26 AIRPORT SQ",
            "city": "NORTH WALES",
            "state": "PA",
            "postal_code": "194541419",
            "telephone_number": "215-362-1177",
            "fax_number": "215-362-7026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26 AIRPORT SQ",
            "city": "NORTH WALES",
            "state": "PA",
            "postal_code": "194541419",
            "telephone_number": "215-362-1177",
            "fax_number": "215-362-7026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSENBERG",
        "first_name": "ALAN",
        "middle_name": "MARC",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-16",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "5554-T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4358124",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS/PC",
            "identifier": "1457400",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "KEYSTONE",
            "identifier": "2146183000",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in North Wales, PA

Sources for this page

Verify at the official NPI Registry.