Provider Demographics
NPI:1972696821
Name:JOHN G ROCHE OPTICIANS INC
Entity type:Organization
Organization Name:JOHN G ROCHE OPTICIANS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:ROCHE
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:859-745-1400
Mailing Address - Street 1:PO BOX 4255
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40392-4255
Mailing Address - Country:US
Mailing Address - Phone:859-745-1400
Mailing Address - Fax:859-744-1454
Practice Address - Street 1:2560 BYPASS RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-2387
Practice Address - Country:US
Practice Address - Phone:859-745-1400
Practice Address - Fax:859-744-1454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY495156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYKY0495OtherEYEMED PROVIDER ID
KY000000193514OtherBC/BS PROVIDER NUMBER
KYKY0495OtherEYEMED PROVIDER ID