Individual
BRANDON DOUGLAS ROUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1301 COOK ST, KENNETT, MO 63857-3259
(573) 888-2884
(575) 888-3799
Mailing address
PO BOX 807, 1301 COOK ST, KENNETT, MO 63857
(573) 888-2884
(575) 888-3799
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T03483
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
314803701
—
MO
Enumeration date
08/18/2006
Last updated
12/04/2012
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