MEDICARE: DR. MARY BETH RHOMBERG O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	046-009203	IL
2	152W00000X	Optometrist	T03344	MO

General Provider Information

NPI Number	:	1144210519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY BETH RHOMBERG O.D.

Provider Business Mailing Address
First Line	:	1 UNIVERSITY BLVD
Second Line	:	PATIENT CARE CENTER
City	:	SAINT LOUIS
State	:	MO
Zip	:	63121-4400
Country	:	US
Telephone Number	:	314-516-5131
Fax Number	:	314-516-5507

Provider Business Practice Location Address
First Line	:	7840 NATURAL BRIDGE RD
Second Line	:	PATIENT CARE CENTER
City	:	ST. LOUIS
State	:	MO
Zip	:	63121-4617
Country	:	US
Telephone Number	:	314-516-5131
Fax Number	:	314-516-5507

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	06/10/2020

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