Provider Demographics
NPI:1760647960
Name:ROGERS, KEVIN A (OD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:A
Last Name:ROGERS
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:18522 MAGNOLIA BRIDGE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENWELL SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70739-4662
Mailing Address - Country:US
Mailing Address - Phone:225-261-6282
Mailing Address - Fax:225-261-6012
Practice Address - Street 1:18522 MAGNOLIA BRIDGE RD
Practice Address - Street 2:SUITE A
Practice Address - City:GREENWELL SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70739-4662
Practice Address - Country:US
Practice Address - Phone:225-261-6282
Practice Address - Fax:225-261-6012
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA1560-592T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1309176Medicaid
LA4R143DK72Medicare PIN