MEDICARE: MR. ROGER HALPHEN OPTICIAN

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	156FX1800X	Optician	DO 2506	FL

General Provider Information

NPI Number	:	1205954682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROGER HALPHEN OPTICIAN

Provider Business Mailing Address
First Line	:	56 CURTISS PKWY
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-5219
Country	:	US
Telephone Number	:	305-883-1105
Fax Number	:	305-883-9928

Provider Business Practice Location Address
First Line	:	56 CURTISS PKWY
Second Line	:
City	:	MIAMI SPRINGS
State	:	FL
Zip	:	33166-5219
Country	:	US
Telephone Number	:	305-883-1105
Fax Number	:	305-883-9928

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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