Healthcare Provider Details

I. General information

NPI: 1811293731
Provider Name (Legal Business Name): KAREN B. ROSEN, O. D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2011
Last Update Date: 08/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 RONNIES PLZ
SAINT LOUIS MO
63126-3552
US

IV. Provider business mailing address

17 RONNIES PLZ
SAINT LOUIS MO
63126-3552
US

V. Phone/Fax

Practice location:
  • Phone: 314-843-2020
  • Fax:
Mailing address:
  • Phone: 314-843-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT02578
License Number StateMO

VIII. Authorized Official

Name: DR. KAREN B ROSEN
Title or Position: OWNER
Credential: O.D.
Phone: 314-843-2020