Provider Demographics
NPI:1619951274
Name:ROSEN, STEVEN E (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:E
Last Name:ROSEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 CONWAY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-1958
Mailing Address - Country:US
Mailing Address - Phone:636-537-1377
Mailing Address - Fax:
Practice Address - Street 1:474 CRESTWOOD PLZ
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63126-1704
Practice Address - Country:US
Practice Address - Phone:314-968-3660
Practice Address - Fax:314-968-3559
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO2404152W00000X
AZ582152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO311723613Medicaid
MO21537OtherHEALTHCARE USA
MO108646OtherBCBS OF MISSOURI
MO254718OtherHEALTHLINK
MO31297OtherOPTICARE-OEHN
MO22-00854OtherUNITED HEALTHCARE
MO000091105Medicare PIN
MO254718OtherHEALTHLINK
MO21537OtherHEALTHCARE USA
MO410022487Medicare PIN
MO000091103Medicare PIN