Provider Demographics
NPI:1912169731
Name:HOMAN, ROGER A
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:A
Last Name:HOMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:SENECAFALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13148
Mailing Address - Country:US
Mailing Address - Phone:315-568-4277
Mailing Address - Fax:315-468-4277
Practice Address - Street 1:3662 THE PARK
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045-2001
Practice Address - Country:US
Practice Address - Phone:607-753-7514
Practice Address - Fax:607-753-7515
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007665-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician