Provider Demographics
NPI:1255301156
Name:ROGENTHIEN, RICHARD E (OD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:ROGENTHIEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895-1152
Mailing Address - Country:US
Mailing Address - Phone:585-593-6369
Mailing Address - Fax:
Practice Address - Street 1:178 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-1152
Practice Address - Country:US
Practice Address - Phone:585-593-6369
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT002851-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD6435Medicare ID - Type UnspecifiedUPSTATE MEDICARE