Individual provider Active NPI

Roseline Larsen

  • Optometrist
  • San Juan, PR
National Provider Identifier
1255945309
Registry record updated Sep 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
407 Issued in PR
Practice address
300 Ave la Sierra # 118M-24
San Juan, PR 00926-4330
Phone
(787) 717-8299
NPI assigned
Sep 5, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 5, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 407 PR Primary

Addresses

Primary practice location

300 Ave la Sierra # 118M-24
San Juan, PR 00926-4330

Mailing address

300 Ave la Sierra # 118M-24
San Juan, PR 00926-4330
Phone (787) 717-8299

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PR
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
I20210121002876 PR Practitioner - Optometry 0749694354 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
The Looks Optical LLC Optometrist CurrentSince Nov 5, 2020 Accepting new patients

Organizations & group practices 1

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": "1599264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599264000000",
    "number": "1255945309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 AVE LA SIERRA # 118M-24",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009264330",
            "telephone_number": "787-717-8299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 AVE LA SIERRA # 118M-24",
            "city": "SAN JUAN",
            "state": "PR",
            "postal_code": "009264330",
            "telephone_number": "787-717-8299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "ROSELINE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-05",
        "last_updated": "2020-09-05",
        "certification_date": "2020-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PR",
            "license": "407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Juan, PR

Sources for this page

Verify at the official NPI Registry.