MEDICARE: JASON ROSE OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2001024885	MO

General Provider Information

NPI Number	:	1548421373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON ROSE OD

Provider Business Mailing Address
First Line	:	1713 GIBSON ST
Second Line	:
City	:	WEST PLAINS
State	:	MO
Zip	:	65775-1815
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1713 GIBSON ST
Second Line	:
City	:	WEST PLAINS
State	:	MO
Zip	:	65775-1815
Country	:	US
Telephone Number	:	417-256-8393
Fax Number	:	417-256-8393

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2008
Last Update Date	:	07/03/2008

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Directions to “ JASON ROSE OD” Practice Location

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