Healthcare Provider Details

I. General information

NPI: 1386670099
Provider Name (Legal Business Name): ROSENTHAL OPTOMETRIC ASSOCIATION LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

823 9TH ST
HIGHLAND IL
62249-1521
US

IV. Provider business mailing address

823 9TH ST
HIGHLAND IL
62249-1521
US

V. Phone/Fax

Practice location:
  • Phone: 618-654-9848
  • Fax: 618-654-5200
Mailing address:
  • Phone: 618-654-9848
  • Fax: 618-654-5200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number046008913
License Number StateIL

VIII. Authorized Official

Name: DR. KIMBERLY ROSENTHAL TINGE
Title or Position: DOCTOR
Credential: O. D.
Phone: 618-654-9848