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NPI Code Detail

MEDICARE: DR. PHILIP M ROELS OD

MEDICARE: DR. PHILIP M ROELS 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
1152W00000XOptometrist1937NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1093R1OTHERNCBCBS NC
27833605OTHERNCAETNA
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1578548616
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. PHILIP M ROELS OD
Provider Business Mailing Address
First Line : 316 SPRINGWATER CT
Second Line :
City : WINSTON SALEM
State : NC
Zip : 27106-4487
Country : US
Telephone Number : 336-588-4969
Fax Number :
Provider Business Practice Location Address
First Line : 1601 BRENNER AVE
Second Line : EYE CLINIC (11I)
City : SALISBURY
State : NC
Zip : 28144-2515
Country : US
Telephone Number : 704-638-9000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2005
Last Update Date : 05/02/2025

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