Healthcare Provider Details

I. General information

NPI: 1972696821
Provider Name (Legal Business Name): JOHN G ROCHE OPTICIANS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 BYPASS RD
WINCHESTER KY
40391-2387
US

IV. Provider business mailing address

PO BOX 4255
WINCHESTER KY
40392-4255
US

V. Phone/Fax

Practice location:
  • Phone: 859-745-1400
  • Fax: 859-744-1454
Mailing address:
  • Phone: 859-745-1400
  • Fax: 859-744-1454

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number495
License Number StateKY

VIII. Authorized Official

Name: MR. JOHN G ROCHE
Title or Position: OPTICIAN/OWNER
Credential: OPTICIAN
Phone: 859-745-1400