Provider Demographics
NPI:1417692500
Name:ROTHEKER, MATTHEW J (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:J
Last Name:ROTHEKER
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7211 TAFT ST
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-3731
Mailing Address - Country:US
Mailing Address - Phone:219-769-6367
Mailing Address - Fax:219-769-7362
Practice Address - Street 1:7211 TAFT ST
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-3731
Practice Address - Country:US
Practice Address - Phone:219-769-6367
Practice Address - Fax:219-769-7362
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician