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General NPI Number Information
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NPI Number | 1962146639
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Entity Type | Organization
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Legal Business Name | ROSE ROCK EYECARE PLLC
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Dates
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Enumeration Date | 04/27/2022
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Last Update Date | 09/05/2022
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Provider Practice Location Address
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Address Line | 317 E AQUARIUM PL
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City | JENKS
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State | OK
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Zip | 74037-6811
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Country | US
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Telephone | 918-296-4733
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Fax |
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Provider Business Mailing Address
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Address Line | 14614 JORDAN CT
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City | GLENPOOL
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State | OK
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Zip | 74033-6013
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Country | US
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Telephone | 712-541-1434
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. BRITTANY WOLTHUIZEN
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Credential | OD
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Telephone | 712-541-1434
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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