Organization
ROSE OPTICAL, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARIE ANNETTE MANGRUM (BOARD SECRETARY/TREAS.)
(618) 466-8787
Entity
Organization
Contact information
Practice address
3300 GODFREY RD, GODFREY, IL 62035-2558
(618) 466-8787
(618) 466-4703
Mailing address
PO BOX 5040, GODFREY, IL 62035-5040
(618) 466-8787
(618) 466-4703
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
22652655
IL
Other
Enumeration date
02/02/2006
Last updated
08/29/2011
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