MEDICARE: DR. ROGER D. AMMON O.D.

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	I3-0001250	DE
2	152W00000X	Optometrist	OEG000774	PA

General Provider Information

NPI Number	:	1144311010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER D. AMMON O.D.

Provider Business Mailing Address
First Line	:	2205 CONCORD PIKE
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19803-2908
Country	:	US
Telephone Number	:	302-655-1952
Fax Number	:	302-655-5601

Provider Business Practice Location Address
First Line	:	2205 CONCORD PIKE
Second Line	:
City	:	WILMINGTON
State	:	DE
Zip	:	19803-2908
Country	:	US
Telephone Number	:	302-655-1952
Fax Number	:	302-655-1952

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	12/09/2009

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