Provider Demographics
NPI:1255317616
Name:TOTTEN, ROGER BYRON (OD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:BYRON
Last Name:TOTTEN
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:PO BOX 97
Mailing Address - Street 2:102 SPRING STREET
Mailing Address - City:MELBOURNE
Mailing Address - State:AR
Mailing Address - Zip Code:72556-0097
Mailing Address - Country:US
Mailing Address - Phone:870-368-7921
Mailing Address - Fax:870-368-7789
Practice Address - Street 1:102 SPRING STREET
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:AR
Practice Address - Zip Code:72556-0097
Practice Address - Country:US
Practice Address - Phone:870-368-7921
Practice Address - Fax:870-368-7789
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2195152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102791722Medicaid
AR410047231Medicare PIN
AR102791722Medicaid
AR48551-F969Medicare PIN
AR48551Medicare PIN