Provider Demographics
NPI:1821017047
Name:ROTTINGHAUS, CHARLES ALBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:ALBERT
Last Name:ROTTINGHAUS
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 1:4734 NW VALENCIA RD
Mailing Address - Street 2:
Mailing Address - City:SILVER LAKE
Mailing Address - State:KS
Mailing Address - Zip Code:66539-9312
Mailing Address - Country:US
Mailing Address - Phone:785-582-4553
Mailing Address - Fax:
Practice Address - Street 1:200 E 6TH AVE
Practice Address - Street 2:SUITE 112
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66603-3517
Practice Address - Country:US
Practice Address - Phone:785-235-2374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2011-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1722152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist