Provider Demographics
NPI:1487662409
Name:MCCARTHY, ROGER D (OD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:D
Last Name:MCCARTHY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:P O BOX 92
Mailing Address - Street 2:2 OLD SNAKE POND RD
Mailing Address - City:FORESTDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02644-0092
Mailing Address - Country:US
Mailing Address - Phone:978-807-3163
Mailing Address - Fax:508-477-0846
Practice Address - Street 1:17 DAVIS STRAITS
Practice Address - Street 2:FALMOUTH
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-3905
Practice Address - Country:US
Practice Address - Phone:978-807-3163
Practice Address - Fax:508-477-0846
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA2119152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0397377Medicaid
MA0397377Medicaid
064058Medicare ID - Type Unspecified