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
Fax: (574) 234-8408
Website:

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316935208 NPPES
Indiana Other 000000215766 ANTHEM MC/BS
Indiana MEDICAID 200335390A ANTHEM MC/BS

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