Provider Demographics
NPI:1427551894
Name:TARY VISION LLC
Entity Type:Organization
Organization Name:TARY VISION LLC
Other - Org Name:ROSEN OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:TARY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:636-208-2832
Mailing Address - Street 1:844 KONERT HILL DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-7176
Mailing Address - Country:US
Mailing Address - Phone:636-208-2832
Mailing Address - Fax:
Practice Address - Street 1:17 RONNIES PLZ
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-3552
Practice Address - Country:US
Practice Address - Phone:314-843-2020
Practice Address - Fax:314-843-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-13
Last Update Date:2018-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014018412152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty