Provider Demographics
NPI:1962599944
Name:ROTH, ALAN JAY (OD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:JAY
Last Name:ROTH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:700 POWDER MILL LN
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-4035
Mailing Address - Country:US
Mailing Address - Phone:610-642-0801
Mailing Address - Fax:215-546-1943
Practice Address - Street 1:1315 WALNUT ST
Practice Address - Street 2:AMERICAS BEST
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4719
Practice Address - Country:US
Practice Address - Phone:215-546-1666
Practice Address - Fax:215-546-1943
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOEG000696152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist