Provider Demographics
NPI:1063690733
Name:STUART D ROGERS, OD
Entity type:Organization
Organization Name:STUART D ROGERS, OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROGERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:731-989-2711
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-0159
Mailing Address - Country:US
Mailing Address - Phone:731-989-2711
Mailing Address - Fax:731-989-2778
Practice Address - Street 1:124 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-1800
Practice Address - Country:US
Practice Address - Phone:731-989-2711
Practice Address - Fax:731-989-2778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT857332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0292970001Medicare NSC