Provider Demographics
NPI:1033250964
Name:BETZ, ROSE M (OD)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:M
Last Name:BETZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:15933 CLAYTON RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-2172
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:801 APPLEJACK BLVD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-3401
Practice Address - Country:US
Practice Address - Phone:205-333-0016
Practice Address - Fax:205-339-6751
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALS470TA104152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1074080007Medicare NSC
AL34852Medicare PIN
T69134Medicare UPIN