Healthcare Provider Details

I. General information

NPI: 1962146639
Provider Name (Legal Business Name): ROSE ROCK EYECARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 09/05/2022
Certification Date: 09/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 E AQUARIUM PL
JENKS OK
74037-6811
US

IV. Provider business mailing address

14614 JORDAN CT
GLENPOOL OK
74033-6013
US

V. Phone/Fax

Practice location:
  • Phone: 918-296-4733
  • Fax:
Mailing address:
  • Phone: 712-541-1434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRITTANY WOLTHUIZEN
Title or Position: OPTOMETRIST
Credential: OD
Phone: 712-541-1434