MEDICARE: DR. ROGER A OTTO 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	OPC1436	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4354230001	OTHER	FL	DMEC MEDICARE

General Provider Information

NPI Number	:	1831148675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROGER A OTTO O.D.

Provider Business Mailing Address
First Line	:	1444 KENNEDY DR
Second Line	:
City	:	KEY WEST
State	:	FL
Zip	:	33040-4008
Country	:	US
Telephone Number	:	305-294-9711
Fax Number	:	305-294-2456

Provider Business Practice Location Address
First Line	:	1444 KENNEDY DR
Second Line	:
City	:	KEY WEST
State	:	FL
Zip	:	33040-4008
Country	:	US
Telephone Number	:	305-294-9711
Fax Number	:	305-294-2456

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

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	12/11/2008

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Directions to “ DR. ROGER A OTTO O.D.” Practice Location

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