MEDICARE: DR. BERNIE V ROTTACH 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	1546	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	214140663001	OTHER	MN	PREFERRED ONE
2	2201983	OTHER	MN	MEDICA EXAM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	144L5RO	OTHER	MN	BLUE CROSS & BLUE SHIELD OF MN
5	2100307	OTHER	MN	MEDICA EYEWEAR
6	200111404	OTHER	MN	HEALTHPARTNERS

General Provider Information

NPI Number	:	1427052323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERNIE V ROTTACH O.D.

Provider Business Mailing Address
First Line	:	2204 COMMERCE BLVD
Second Line	:
City	:	MOUND
State	:	MN
Zip	:	55364-1547
Country	:	US
Telephone Number	:	952-472-3937
Fax Number	:	952-472-7487

Provider Business Practice Location Address
First Line	:	2204 COMMERCE BLVD
Second Line	:
City	:	MOUND
State	:	MN
Zip	:	55364-1547
Country	:	US
Telephone Number	:	952-472-3937
Fax Number	:	952-472-7487

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	05/08/2008

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