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NPI Code Detail

MEDICARE: DR. GLENN K. ROTER O.D.

MEDICARE: DR. GLENN K. ROTER O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist411NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245316629
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GLENN K. ROTER O.D.
Provider Business Mailing Address
First Line : 5200 S FORT APACHE RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-1722
Country : US
Telephone Number : 702-368-0092
Fax Number : 702-368-0097
Provider Business Practice Location Address
First Line : 5200 S FORT APACHE RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89148-1722
Country : US
Telephone Number : 702-368-0092
Fax Number : 702-368-0097
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2006
Last Update Date : 11/16/2010

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