Healthcare Provider Details

I. General information

NPI: 1801887534
Provider Name (Legal Business Name): ROGER C MCCARTNEY OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 12/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 M ST
ORD NE
68862-1428
US

IV. Provider business mailing address

800 S 23RD ST PO BOX 312
ORD NE
68862-1674
US

V. Phone/Fax

Practice location:
  • Phone: 308-728-3229
  • Fax: 308-728-5908
Mailing address:
  • Phone: 308-728-3420
  • Fax: 308-728-5908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number809
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: