MEDICARE: DR. CHARLES ALBERT ROTTINGHAUS 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	1722	KS

General Provider Information

NPI Number	:	1821017047
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES ALBERT ROTTINGHAUS O.D.

Provider Business Mailing Address
First Line	:	4734 NW VALENCIA RD
Second Line	:
City	:	SILVER LAKE
State	:	KS
Zip	:	66539-9312
Country	:	US
Telephone Number	:	785-582-4553
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 E 6TH AVE
Second Line	:	SUITE 112
City	:	TOPEKA
State	:	KS
Zip	:	66603-3517
Country	:	US
Telephone Number	:	785-235-2374
Fax Number	:

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

Provider Enumeration Date	:	07/19/2006
Last Update Date	:	09/22/2011

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