Healthcare Provider Details

I. General information

NPI: 1982719274
Provider Name (Legal Business Name): ROGER ROMANCHIK OPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 MAIN ST
HELLERTOWN PA
18055-1320
US

IV. Provider business mailing address

1225 MAIN ST
HELLERTOWN PA
18055-1320
US

V. Phone/Fax

Practice location:
  • Phone: 610-838-7220
  • Fax: 610-838-7806
Mailing address:
  • Phone: 610-838-7220
  • Fax: 610-838-7806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number83307368
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: