MEDICARE: PETER J ROTHERMEL 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
1	152W00000X	Optometrist	04937T	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	80933Q	OTHER	TX	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912945726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETER J ROTHERMEL OD

Provider Business Mailing Address
First Line	:	205 B WEST WATER
Second Line	:
City	:	KERRVILLE
State	:	TX
Zip	:	78028-2737
Country	:	US
Telephone Number	:	830-792-5880
Fax Number	:

Provider Business Practice Location Address
First Line	:	205 B WEST WATER
Second Line	:
City	:	KERRVILLE
State	:	TX
Zip	:	78028-2737
Country	:	US
Telephone Number	:	830-792-5880
Fax Number	:

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	06/25/2014

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