Individual
DOUGLAS G ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
390 MID RIVERS MALL DR, SUITE 290, SAINT PETERS, MO 63376-1565
(636) 279-2020
(636) 279-1055
Mailing address
40 E NORTH ST, EUREKA, MO 63025-1205
(636) 200-4393
(636) 938-2650
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2002016606
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285654418
—
MO
Enumeration date
07/20/2006
Last updated
11/18/2014
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