Provider Demographics
NPI:1548416423
Name:ROACH, CAROLANNE HOPE (OD)
Entity Type:Individual
Prefix:DR
First Name:CAROLANNE
Middle Name:HOPE
Last Name:ROACH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1530 SW 89TH ST STE D2
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-6366
Mailing Address - Country:US
Mailing Address - Phone:405-703-3163
Mailing Address - Fax:405-353-6718
Practice Address - Street 1:1530 SW 89TH ST STE D2
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6366
Practice Address - Country:US
Practice Address - Phone:405-703-3163
Practice Address - Fax:405-353-6718
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2581152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision