Provider Demographics
NPI:1598755886
Name:VESPER, ROGER LAWRENCE (OD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:LAWRENCE
Last Name:VESPER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:43375 W COURTNEY DR
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85239-2396
Mailing Address - Country:US
Mailing Address - Phone:480-445-9063
Mailing Address - Fax:480-882-0799
Practice Address - Street 1:21300 NORTH JOHN WAYNE PARKWAY
Practice Address - Street 2:SUITE 119
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85239-2396
Practice Address - Country:US
Practice Address - Phone:520-568-7538
Practice Address - Fax:520-413-3132
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1383152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ876443Medicaid
AZ876443Medicaid