Provider Demographics
NPI:1235538125
Name:ROARK, CATHLEEN (OD)
Entity Type:Individual
Prefix:DR
First Name:CATHLEEN
Middle Name:
Last Name:ROARK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18814 BRIAR ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68136-1626
Mailing Address - Country:US
Mailing Address - Phone:308-940-0876
Mailing Address - Fax:
Practice Address - Street 1:11844 STANDING STONE DR STE 100
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:NE
Practice Address - Zip Code:68028-7979
Practice Address - Country:US
Practice Address - Phone:402-687-3435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-18
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1422152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist