Provider Demographics
NPI:1225243751
Name:MICHAEL L. ROETMAN, O.D.P.C.
Entity Type:Organization
Organization Name:MICHAEL L. ROETMAN, O.D.P.C.
Other - Org Name:FAMILY EYE & VISION CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ROETMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-472-3464
Mailing Address - Street 1:502 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:51246-1014
Mailing Address - Country:US
Mailing Address - Phone:712-472-3464
Mailing Address - Fax:712-472-2788
Practice Address - Street 1:502 1ST AVE
Practice Address - Street 2:
Practice Address - City:ROCK RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:51246-1014
Practice Address - Country:US
Practice Address - Phone:712-472-3464
Practice Address - Fax:712-472-2788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA1754152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0114165Medicaid
IAI6226Medicare PIN
IA0564250001Medicare NSC