Provider Demographics
NPI:1841372166
Name:ROSENAK, STEVEN WEBER (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:WEBER
Last Name:ROSENAK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2229A NORTH BELT HIGHWAY
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02736152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0000568OtherPTAN
19465031OtherBLUE CROSS BLUE SHIELD
MO1312000001Medicare NSC
MOU34731Medicare UPIN