MEDICARE: DR. DAVID ROCKS OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	046-009272	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00450771	OTHER		MEDICARE RAILROAD PTAN

General Provider Information

NPI Number	:	1023016151
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID ROCKS OD

Provider Business Mailing Address
First Line	:	45 W ACORN LN
Second Line	:
City	:	LAKE IN THE HILLS
State	:	IL
Zip	:	60156-4804
Country	:	US
Telephone Number	:	847-854-0202
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 W ACORN LN
Second Line	:
City	:	LAKE IN THE HILLS
State	:	IL
Zip	:	60156-4804
Country	:	US
Telephone Number	:	847-854-0202
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2005
Last Update Date	:	07/30/2019

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