Provider Demographics
NPI:1063571271
Name:DR. ROSENAK'S OPTICAL OPTIONS, INC.
Entity type:Organization
Organization Name:DR. ROSENAK'S OPTICAL OPTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:WEBER
Authorized Official - Last Name:ROSENAK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:816-671-0500
Mailing Address - Street 1:2229 N BELT HWY STE A
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-2481
Mailing Address - Country:US
Mailing Address - Phone:816-671-0500
Mailing Address - Fax:816-671-0600
Practice Address - Street 1:2229 N BELT HWY STE A
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2481
Practice Address - Country:US
Practice Address - Phone:816-671-0500
Practice Address - Fax:816-671-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02736332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO410024941OtherRAILROAD PTAN
MO0000568OtherPTAN
MO410024941OtherRAILROAD PTAN