Provider Demographics
NPI:1861406274
Name:ROTTMAN, RANDALL JAY (MD)
Entity type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:JAY
Last Name:ROTTMAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1190 BOOKCLIFF AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-8133
Mailing Address - Country:US
Mailing Address - Phone:970-242-3323
Mailing Address - Fax:970-242-8774
Practice Address - Street 1:1190 BOOKCLIFF AVE
Practice Address - Street 2:STE 102 ROTTMAN EYE CARE, PC
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8133
Practice Address - Country:US
Practice Address - Phone:970-242-3323
Practice Address - Fax:970-242-8774
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2011-01-18
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Provider Licenses
StateLicense IDTaxonomies
CO28155207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07671270Medicaid
COC808774Medicare PIN
E94490Medicare UPIN