Healthcare Provider Details

I. General information

NPI: 1982676128
Provider Name (Legal Business Name): ROGER LEE SANEHOLTZ OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 04/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W MAIN ST
MONTPELIER OH
43543
US

IV. Provider business mailing address

306 W MAIN ST
MONTPELIER OH
43543
US

V. Phone/Fax

Practice location:
  • Phone: 419-485-4257
  • Fax: 419-485-3520
Mailing address:
  • Phone: 419-485-4257
  • Fax: 419-485-3520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOH3144
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT635
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: