Provider Demographics
NPI:1629051693
Name:ROGASKI, PETER MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:MICHAEL
Last Name:ROGASKI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 RANDOLPH ST
Mailing Address - Street 2:STE 1415
Mailing Address - City:THOMASVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27360-6383
Mailing Address - Country:US
Mailing Address - Phone:336-472-8700
Mailing Address - Fax:336-472-8740
Practice Address - Street 1:1040 RANDOLPH ST
Practice Address - Street 2:STE 1415
Practice Address - City:THOMASVILLE
Practice Address - State:NC
Practice Address - Zip Code:27360-6383
Practice Address - Country:US
Practice Address - Phone:336-472-8700
Practice Address - Fax:336-472-8740
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC1741152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909258Medicaid
NC8909258Medicaid
NC2471793Medicare ID - Type Unspecified