Provider Demographics
NPI:1366410037
Name:ROTEN, PAUL CURTIS (OD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:CURTIS
Last Name:ROTEN
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 1:1936 ROSS CLARK CIR
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36301-5750
Mailing Address - Country:US
Mailing Address - Phone:334-794-0585
Mailing Address - Fax:337-671-4943
Practice Address - Street 1:1936 ROSS CLARK CIR
Practice Address - Street 2:
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-5750
Practice Address - Country:US
Practice Address - Phone:334-794-0585
Practice Address - Fax:337-671-4943
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS313-TA-244152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000059281Medicaid
AL000059281Medicaid
ALT69048Medicare UPIN