Provider Demographics
NPI:1851070122
Name:ROLWING, HEATH PATRICK (OD)
Entity Type:Individual
Prefix:
First Name:HEATH
Middle Name:PATRICK
Last Name:ROLWING
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 1:892 N 219TH RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63834-9243
Mailing Address - Country:US
Mailing Address - Phone:573-683-0435
Mailing Address - Fax:
Practice Address - Street 1:222 E COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:MO
Practice Address - Zip Code:63834-1749
Practice Address - Country:US
Practice Address - Phone:573-233-8168
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-14
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023027695152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist