Basic Information
| Provider Information | |||||||||
| NPI: | 1033250964 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BETZ | ||||||||
| FirstName: | ROSE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15933 CLAYTON RD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | BALLWIN | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630112172 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6362004393 | ||||||||
| FaxNumber: | 6365270766 | ||||||||
| Practice Location | |||||||||
| Address1: | 801 APPLEJACK BLVD | ||||||||
| Address2: | |||||||||
| City: | NORTHPORT | ||||||||
| State: | AL | ||||||||
| PostalCode: | 354733401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2053330016 | ||||||||
| FaxNumber: | 2053396751 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2007 | ||||||||
| LastUpdateDate: | 11/15/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | S470TA104 | AL | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.