Healthcare Provider Details

I. General information

NPI: 1821760422
Provider Name (Legal Business Name): JOSEPH BARRINGTON ROTH OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2021
Last Update Date: 10/01/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

122 S COUNTY CENTER WAY STE A
SAINT LOUIS MO
63129-1092
US

IV. Provider business mailing address

122 S COUNTY CENTER WAY STE A
SAINT LOUIS MO
63129-1092
US

V. Phone/Fax

Practice location:
  • Phone: 314-416-7588
  • Fax:
Mailing address:
  • Phone: 314-416-7588
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2021036475
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: