Provider Demographics
NPI:1649243783
Name:ROGERS, JANET E (OD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:E
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:PO BOX 1118
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-9123
Mailing Address - Country:US
Mailing Address - Phone:804-748-4877
Mailing Address - Fax:804-796-9168
Practice Address - Street 1:9440 IRONBRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23875-6601
Practice Address - Country:US
Practice Address - Phone:804-748-4877
Practice Address - Fax:804-796-9168
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001506152W00000X, 152WC0802X, 152WP0200X, 152WS0006X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAV07547Medicare UPIN
VA009193C89Medicare ID - Type Unspecified