Provider Demographics
NPI:1851467872
Name:RODGERS, LARRY MORGAN (O D)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:MORGAN
Last Name:RODGERS
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5757A ATLANTA HWY
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36117-2150
Mailing Address - Country:US
Mailing Address - Phone:334-271-3405
Mailing Address - Fax:334-277-3016
Practice Address - Street 1:5757A ATLANTA HWY
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-2150
Practice Address - Country:US
Practice Address - Phone:334-271-3405
Practice Address - Fax:334-277-3016
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-617-TA-320152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51033649OtherBLUE CROSS BLUE SHIELD
AL51058051OtherBLUE CROSS BLUE SHIELD
AL51098555OtherBLUE CROSS BLUE SHIELD
AL000058051Medicaid
AL51033649OtherBLUE CROSS BLUE SHIELD
ALT69047Medicare UPIN