Healthcare Provider Details

I. General information

NPI: 1063465110
Provider Name (Legal Business Name): ROGER TODD ADLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 S 14TH ST
PEKIN IL
61554-5073
US

IV. Provider business mailing address

725 S 14TH ST
PEKIN IL
61554-5073
US

V. Phone/Fax

Practice location:
  • Phone: 309-353-6660
  • Fax: 309-353-7664
Mailing address:
  • Phone: 309-353-6660
  • Fax: 309-353-7664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number036-107471
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: