MEDICARE: DR. DAVID KEATING ROELL 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	OA5256	NJ

General Provider Information

NPI Number	:	1629023577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID KEATING ROELL O.D.

Provider Business Mailing Address
First Line	:	121 LIGHTHOUSE LN
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-6990
Country	:	US
Telephone Number	:	609-601-9982
Fax Number	:

Provider Business Practice Location Address
First Line	:	3007 OCEAN HEIGHTS AVE STE 105
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-7749
Country	:	US
Telephone Number	:	609-653-9933
Fax Number	:

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

Provider Enumeration Date	:	05/22/2006
Last Update Date	:	06/15/2010

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