Individual provider Active NPI

Rosalyn Angela Lilienthal, OD

  • Optometrist
  • Holbrook, NY
National Provider Identifier
1932845435
Registry record updated Jul 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC6105 Issued in FL
Practice address
20 Peachtree CT Ste H&103a
Holbrook, NY 11741-4616
Phone
(844) 843-2020
NPI assigned
May 7, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 15, 2026

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

Specialties & licenses 15

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 1089 NH
Optometrist 152W00000X 3822 TN
Optometrist 152W00000X OPT-002626 AZ
Optometrist 152W00000X OEG003960 PA
Optometrist 152W00000X 046011707 IL
Optometrist 152W00000X S-F12-TA-C78 AL
Optometrist 152W00000X 115200 IA
Optometrist 152W00000X 10727 TX
Optometrist 152W00000X ODTG00747 RI
Optometrist 152W00000X TA2876 MD
Optometrist 152W00000X OPC6105 FL Primary
Optometrist 152W00000X 003310 CT
Optometrist 152W00000X 009688 NY
Optometrist 152W00000X OPT.0004028 CO
Optometrist 152W00000X 0618003156 VA

Addresses

Primary practice location

20 Peachtree CT Ste H&103a
Holbrook, NY 11741-4616

Mailing address

17249 Lawrence Way
Grass Valley, CA 95949-7175

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
I20240808000947 PA Practitioner - Optometry 9032656012 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
New England College of Optometry, 2022
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1 Vermont Dr
New Hyde Park, NY 11042-1128

2121 Ala Wai Blvd
Apt 3306
Honolulu, HI 96815-2209

5 Dakota Dr
Suite 307
New Hyde Park, NY 11042-1106

5 Dakota Dr
Suite 307
New Hyde Park, NY 11042-1188

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
TBDFLMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
20/20 Vision Services PC Optometrist CurrentSince Jul 22, 2024 Accepting new patients

Locations

20 Peachtree Ct
Ste 103H
Holbrook, NY 11741
Phone (201) 572-4039

1887 Elmira St
Sayre, PA 18840
Phone (570) 888-3729

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": "1651881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784073600000",
    "number": "1932845435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17249 LAWRENCE WAY",
            "city": "GRASS VALLEY",
            "state": "CA",
            "postal_code": "959497175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 PEACHTREE CT STE H&103A",
            "city": "HOLBROOK",
            "state": "NY",
            "postal_code": "117414616",
            "telephone_number": "844-843-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LILIENTHAL",
        "first_name": "ROSALYN",
        "middle_name": "ANGELA",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-07",
        "last_updated": "2026-07-15",
        "certification_date": "2026-07-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NH",
            "license": "1089",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TN",
            "license": "3822",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "OPT-002626",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG003960",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "046011707",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AL",
            "license": "S-F12-TA-C78",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IA",
            "license": "115200",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "10727",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "RI",
            "license": "ODTG00747",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA2876",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC6105",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CT",
            "license": "003310",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "009688",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "OPT.0004028",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "VA",
            "license": "0618003156",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Holbrook, NY

Sources for this page

Verify at the official NPI Registry.