Provider Demographics
NPI:1619957446
Name:ROSEN, KAREN BLAIR (OD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:BLAIR
Last Name:ROSEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 RONNIES PLZ
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63126-3552
Mailing Address - Country:US
Mailing Address - Phone:314-843-2020
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:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO 2578152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO21538OtherHEALTHCARE USA
MO22-81371OtherUNITED HEALTHCARE
MO238775OtherHEALTHLINK
MO109014OtherBCBS OF MISSOURI
MO21538OtherHEALTHCARE USA
MO6531960001Medicare NSC
MO22-81371OtherUNITED HEALTHCARE
MO401975Medicare UPIN