Provider Demographics
NPI:1255665741
Name:ROGERS, LAURA LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:LEE
Last Name:ROGERS
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:PO BOX 1857
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-1857
Mailing Address - Country:US
Mailing Address - Phone:916-564-9990
Mailing Address - Fax:916-564-9994
Practice Address - Street 1:650 HOWE AVE
Practice Address - Street 2:SUITE 830
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-4731
Practice Address - Country:US
Practice Address - Phone:916-564-9990
Practice Address - Fax:916-564-9994
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-30
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT11010T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1255665741Medicaid
CAFB237AMedicare PIN