Rose Optical, Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

22652655 Issued in IL

Legal business name

ROSE OPTICAL, INC.

Practice address

3300 Godfrey Rd
Godfrey, IL 62035-2558

Phone

(618) 466-8787

Fax

(618) 466-4703

NPI assigned

Feb 2, 2006

Last updated

Aug 29, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Marie Annette Mangrum

Title

Board Secretary/Treas.

Phone

(618) 466-8787

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mark Edward Ferguson, O.D.

  • Optometrist
  • Godfrey, IL
  • NPI 1598897456
  Medicare reassignment Care Compare group NPD
• Holly Renee Klein, O.D.

  • Optometrist
  • Fairview Heights, IL
  • NPI 1407086945
  Medicare reassignment Care Compare group NPD
• Keith Lyston, O.D.

  • Optometrist
  • Godfrey, IL
  • NPI 1861614810
  Medicare reassignment Care Compare group NPD
• Bradley D Martinson, OD

  • Optometrist
  • Godfrey, IL
  • NPI 1174774079
  Medicare reassignment Care Compare group NPD
• Adeyinka A Adewale, O.D.

  • Optometrist
  • Godfrey, IL
  • NPI 1467533661
  NPD (past)
• Thomas John Johnson, O.D.

  • Optometrist
  • Fairview Heights, IL
  • NPI 1578695425
  NPD (past)
• Ron Loflin, O.D.

  • Optometrist
  • Godfrey, IL
  • NPI 1720170921
  NPD (past)
• Chantal H Jacques, O.D.

  • Optometrist
  • Chantilly, VA
  • NPI 1801025960
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1138838400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314576000000",
    "number": "1669444063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5040",
            "city": "GODFREY",
            "state": "IL",
            "postal_code": "620355040",
            "telephone_number": "618-466-8787",
            "fax_number": "618-466-4703"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 GODFREY RD",
            "city": "GODFREY",
            "state": "IL",
            "postal_code": "620352558",
            "telephone_number": "618-466-8787",
            "fax_number": "618-466-4703"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROSE OPTICAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-02",
        "last_updated": "2011-08-29",
        "status": "A",
        "authorized_official_last_name": "MANGRUM",
        "authorized_official_first_name": "MARIE",
        "authorized_official_middle_name": "ANNETTE",
        "authorized_official_title_or_position": "BOARD SECRETARY/TREAS.",
        "authorized_official_telephone_number": "618-466-8787",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IL",
            "license": "22652655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Riverbend Ophthalmologists, LTD
• Faith Julia Robinson
• Heather Ann Robinson, LPTA
• Gwendolyn Rae Page Rodriguez, BCBA
• Jennifer Marie Roland, M.S. CCC-SLP
• RTS Transportation Services
• Ellen J Rull
• Grant Christian Russell, DMD
• Kaylin Renae Sansone
• Nathan Scandrett, DPT

• Optometrist in Godfrey, IL
• Providers in Godfrey, IL by specialty
• Optometrist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.