Provider Demographics
NPI:1093055469
Name:ROGOT, DAVID (OPHTHALMIC DISPENSE)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:ROGOT
Suffix:
Gender:M
Credentials:OPHTHALMIC DISPENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 MONTAUK HWY
Mailing Address - Street 2:
Mailing Address - City:WESTHAMPTON
Mailing Address - State:NY
Mailing Address - Zip Code:11977-1409
Mailing Address - Country:US
Mailing Address - Phone:917-538-7209
Mailing Address - Fax:
Practice Address - Street 1:125 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON
Practice Address - State:NY
Practice Address - Zip Code:11977-1409
Practice Address - Country:US
Practice Address - Phone:917-538-7209
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-22
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004134156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician