Healthcare Provider Details

I. General information

NPI: 1811959265
Provider Name (Legal Business Name): STUART DOUGLAS ROGERS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 N WASHINGTON AVE
HENDERSON TN
38340-1800
US

IV. Provider business mailing address

124 N WASHINGTON AVE P.O. BOX 159
HENDERSON TN
38340-1800
US

V. Phone/Fax

Practice location:
  • Phone: 731-989-2711
  • Fax: 731-989-2778
Mailing address:
  • Phone: 731-989-2711
  • Fax: 731-989-2778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberODT857
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: