Healthcare Provider Details

I. General information

NPI: 1427052323
Provider Name (Legal Business Name): BERNIE V ROTTACH O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2005
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 CORPORATE CENTER CURV
EAGAN MN
55121-1200
US

IV. Provider business mailing address

2204 COMMERCE BLVD
MOUND MN
55364-1547
US

V. Phone/Fax

Practice location:
  • Phone: 651-756-8177
  • Fax: 651-756-8168
Mailing address:
  • Phone: 952-472-3937
  • Fax: 952-472-7487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1546
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: