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NPI Code Detail

MEDICARE: ROGER L LIGGETT OD

MEDICARE: ROGER L LIGGETT 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
1152W00000XOptometrist18001493AIN
2152W00000XOptometrist18001493BIN

Other Identifiers

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

General Provider Information

NPI Number : 1578511663
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROGER L LIGGETT OD
Provider Business Mailing Address
First Line : 2940 HIGHWAY AVE
Second Line :
City : HIGHLAND
State : IN
Zip : 46322-1631
Country : US
Telephone Number : 219-838-3297
Fax Number : 219-838-3391
Provider Business Practice Location Address
First Line : 2940 HIGHWAY AVE
Second Line :
City : HIGHLAND
State : IN
Zip : 46322-1631
Country : US
Telephone Number : 219-838-3297
Fax Number : 219-838-3391
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 02/23/2018

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Directions to “ ROGER L LIGGETT OD” Practice Location

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