Robertson, Rodger Dean

Robertson, Rodger Dean is an sole proprietor health care provider with primary practice located at 213 N Main St , Moscow ID 83843-2700. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Robertson, Rodger Dean can be contacted via phone (208) 882-2932.

Contact Information

Primary practice address
213 N Main St Moscow ID 83843-2700
Fax: (208) 882-8776
Website:

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X ODP-552 Idaho

Profile Details

NPI number 1265503320
LBN Legal business name Robertson, Rodger Dean
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 12th, 2006
Last updated Jan 13th, 2012 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1265503320 NPPES
Idaho MEDICAID 805042600

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