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General NPI Number Information
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NPI Number | 1235538125
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Entity Type | Individual
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Provider Name | CATHLEEN ROARK OD
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Gender | Female
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Dates
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Enumeration Date | 08/18/2014
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Last Update Date | 08/13/2019
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Provider Practice Location Address
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Address Line | 11844 STANDING STONE DR STE 100
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City | GRETNA
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State | NE
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Zip | 68028-7979
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Country | US
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Telephone | 402-687-3435
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Fax |
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Provider Business Mailing Address
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Address Line | 18814 BRIAR ST
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City | OMAHA
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State | NE
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Zip | 68136-1626
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Country | US
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Telephone | 308-940-0876
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1422
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License Number State | NE
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