Rotheker, Michael John
Rotheker, Michael John is an individual health care provider with primary practice located at 17615 State Road 23 , South Bend IN 46635. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Rotheker, Michael John can be contacted via phone (574) 234-7600.Contact Information
Primary practice address
17615 State Road 23
South Bend IN 46635
Phone: (574) 234-7600
Fax: (574) 234-8408
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 18003124A | Indiana |
Profile Details
| NPI number | 1316935208 |
|---|---|
| LBN Legal business name | Rotheker, Michael John |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 13th, 2005 |
| Last updated | Aug 14th, 2018 - about 8 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 | 1316935208 | NPPES |
| Indiana | Other | 000000215766 | ANTHEM MC/BS |
| Indiana | MEDICAID | 200335390A | ANTHEM MC/BS |
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