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General NPI Number Information
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NPI Number | 1922202977
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Entity Type | Organization
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Legal Business Name | DR. STEVEN S. ROTH, WEST DEPTFORD EYE CARE
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Dates
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Enumeration Date | 06/13/2007
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Last Update Date | 08/12/2008
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Provider Practice Location Address
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Address Line | 1107 MANTUA PIKE SUITE 722
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City | MANTUA
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State | NJ
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Zip | 08051-1606
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Country | US
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Telephone | 856-464-9000
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Fax | 856-464-1577
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Provider Business Mailing Address
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Address Line | 1107 MANTUA PIKE SUITE 722
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City | MANTUA
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State | NJ
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Zip | 08051-1606
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Country | US
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Telephone | 856-464-9000
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Fax | 856-464-1577
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN S. ROTH
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Credential | O.D.
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Telephone | 856-464-9000
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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 | 27OA00378500
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License Number State | NJ
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