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
Phone: (208) 882-2932
Fax: (208) 882-8776
Website:
Health care specialties
| Specialty | Code | License # | 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1265503320 | NPPES |
| Idaho | MEDICAID | 805042600 |
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