MEDICARE: ROGER BYRON TOTTEN 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	2195	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255317616
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROGER BYRON TOTTEN OD

Provider Business Mailing Address
First Line	:	PO BOX 97
Second Line	:	102 SPRING STREET
City	:	MELBOURNE
State	:	AR
Zip	:	72556-0097
Country	:	US
Telephone Number	:	870-368-7921
Fax Number	:	870-368-7789

Provider Business Practice Location Address
First Line	:	102 SPRING STREET
Second Line	:
City	:	MELBOURNE
State	:	AR
Zip	:	72556-0097
Country	:	US
Telephone Number	:	870-368-7921
Fax Number	:	870-368-7789

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

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	05/19/2008

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