Provider Demographics
NPI:1124099981
Name:ROGERS, ROBERT W (OD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:ROGERS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 LIGONIER ST
Mailing Address - Street 2:
Mailing Address - City:LATROBE
Mailing Address - State:PA
Mailing Address - Zip Code:15650-1882
Mailing Address - Country:US
Mailing Address - Phone:724-539-1671
Mailing Address - Fax:724-539-1654
Practice Address - Street 1:1010 LIGONIER ST
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1882
Practice Address - Country:US
Practice Address - Phone:724-539-1671
Practice Address - Fax:724-539-1654
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001241152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008463350004Medicaid
PA0008463350001Medicaid
PAP00433387OtherRAILROAD MEDICARE PTAN
PA0008463350005Medicaid
PA0008463350003Medicaid
PA0008463350001Medicaid
PA189656JP9Medicare PIN