Healthcare Provider Details

I. General information

NPI: 1154402089
Provider Name (Legal Business Name): JOHN CHRISTOPHER ROCKWELL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N WASHINGTON ST
JANESVILLE WI
53548-1500
US

IV. Provider business mailing address

1010 N WASHINGTON ST
JANESVILLE WI
53548-1500
US

V. Phone/Fax

Practice location:
  • Phone: 608-741-6794
  • Fax:
Mailing address:
  • Phone: 608-741-6794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046009840
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3093
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: