Provider Demographics
NPI:1548231947
Name:ROSEN OPTOMETRY ASSOCIATES INC
Entity Type:Organization
Organization Name:ROSEN OPTOMETRY ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:314-968-3660
Mailing Address - Street 1:474 CRESTWOOD PLZ
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-1704
Mailing Address - Country:US
Mailing Address - Phone:314-968-3660
Mailing Address - Fax:314-968-2194
Practice Address - Street 1:474 CRESTWOOD PLZ
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1704
Practice Address - Country:US
Practice Address - Phone:314-968-3660
Practice Address - Fax:314-968-2194
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO 2404152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507396307Medicaid
MOCS9335OtherMEDICARE RAILROAD
MO0851260001Medicare NSC
MOCS9335Medicare PIN
MO990001558Medicare PIN