Provider Demographics
NPI:1235378589
Name:ROGERS, ZOELLA KAY (OWNER AND OPTICIAN)
Entity Type:Individual
Prefix:MRS
First Name:ZOELLA
Middle Name:KAY
Last Name:ROGERS
Suffix:
Gender:F
Credentials:OWNER AND OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5111 ROGERS AVE STE 120P
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-2033
Mailing Address - Country:US
Mailing Address - Phone:479-452-8001
Mailing Address - Fax:479-452-5806
Practice Address - Street 1:5111 ROGERS AVE STE 120P
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-2033
Practice Address - Country:US
Practice Address - Phone:479-452-8001
Practice Address - Fax:479-452-5806
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL-8802156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician