Provider Demographics
NPI:1811293731
Name:KAREN B. ROSEN, O. D., LLC
Entity type:Organization
Organization Name:KAREN B. ROSEN, O. D., LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:B
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:314-843-2020
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-10
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02578152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA3278Medicare PIN
MO6531960001Medicare NSC
MODR4159Medicare PIN