=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003344375
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERIN ROLFES OD, MS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/31/2017
-----------------------------------------------------
Last Update Date | 11/05/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 580 S LOOP RD
-----------------------------------------------------
City | EDGEWOOD
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41017-3415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-331-9000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15933 CLAYTON RD STE 210
-----------------------------------------------------
City | BALLWIN
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63011-2172
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-984-5133
-----------------------------------------------------
Fax | 513-984-4240
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 2073DT
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPT.006579
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------