Provider Demographics
NPI:1477995009
Name:ROGERS, BRITTANY NICOLE (OD)
Entity Type:Individual
Prefix:DR
First Name:BRITTANY
Middle Name:NICOLE
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 1:1200 E COUNTY LINE RD
Mailing Address - Street 2:STE 166
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-1949
Mailing Address - Country:US
Mailing Address - Phone:601-957-6078
Mailing Address - Fax:601-957-6924
Practice Address - Street 1:1200 E COUNTY LINE RD STE 166
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-1949
Practice Address - Country:US
Practice Address - Phone:601-957-6078
Practice Address - Fax:601-957-6924
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS875152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS318534Medicare PIN