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NPI Code Detail

MEDICARE: DR. DENNIS O ROARK OD

MEDICARE: DR. DENNIS O ROARK 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
1152W00000XOptometrist2961OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1200806361028OTHEROHCARESOURCE
210943OTHEROHCORDINATED VISION CARE
32220144OTHEROHUNITED HEALTH CARE
4000000340280OTHEROHINDIVIDUAL
5919227OTHEROHINDIVIDUAL
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1588668081
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DENNIS O ROARK OD
Provider Business Mailing Address
First Line : 313 W HOME RD
Second Line :
City : SPRINGFIELD
State : OH
Zip : 45504-1018
Country : US
Telephone Number : 937-399-1866
Fax Number : 937-399-2346
Provider Business Practice Location Address
First Line : 1674 N LIMESTONE ST
Second Line :
City : SPRINGFIELD
State : OH
Zip : 45503-2652
Country : US
Telephone Number : 937-399-4101
Fax Number : 937-399-2346
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2005
Last Update Date : 07/09/2007

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Directions to “ DR. DENNIS O ROARK OD” Practice Location

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