MEDICARE: DR. FRANK ERNEST ROOFE III 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
1	152W00000X	Optometrist	1022	NC
2	152WC0802X	Corneal and Contact Management Optometrist	1022	NC
3	152WP0200X	Pediatric Optometrist	1022	NC
4	152WL0500X	Low Vision Rehabilitation Optometrist	1022	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	410047692	OTHER	NC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	09773	OTHER	NC	NC BCBS
2	20-5212044	OTHER	NC	EMPLOYER IDENTIFICATION N
4	561288835	OTHER	NC	FEDERAL ID#
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427057868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FRANK ERNEST ROOFE III O.D.

Provider Business Mailing Address
First Line	:	509 E LAUCHWOOD DR
Second Line	:
City	:	LAURINBURG
State	:	NC
Zip	:	28352-5502
Country	:	US
Telephone Number	:	910-276-9256
Fax Number	:	910-276-9254

Provider Business Practice Location Address
First Line	:	509 E LAUCHWOOD DR
Second Line	:
City	:	LAURINBURG
State	:	NC
Zip	:	28352-5502
Country	:	US
Telephone Number	:	910-276-9256
Fax Number	:	910-276-9254

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	12/03/2013

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