Provider Demographics
NPI:1962146639
Name:ROSE ROCK EYECARE PLLC
Entity type:Organization
Organization Name:ROSE ROCK EYECARE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLTHUIZEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-541-1434
Mailing Address - Street 1:14614 JORDAN CT
Mailing Address - Street 2:
Mailing Address - City:GLENPOOL
Mailing Address - State:OK
Mailing Address - Zip Code:74033-6013
Mailing Address - Country:US
Mailing Address - Phone:712-541-1434
Mailing Address - Fax:
Practice Address - Street 1:317 E AQUARIUM PL
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-6811
Practice Address - Country:US
Practice Address - Phone:918-296-4733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-27
Last Update Date:2022-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty