Individual
DR. CHRISTOPHER J DEROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
500 KEENE ST, SUITE 103, COLUMBIA, MO 65201-8104
(573) 874-2030
(573) 884-5575
Mailing address
500 KEENE ST, SUITE 103, COLUMBIA, MO 65201-8104
(573) 874-2030
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
046009246
IL
152W00000X
Optometrist
Primary
2006037577
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
314025008
—
MO
Enumeration date
05/17/2006
Last updated
04/10/2009
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