Provider Demographics
NPI:1982676128
Name:SANEHOLTZ, ROGER LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:LEE
Last Name:SANEHOLTZ
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 1:306 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MONTPELIER
Mailing Address - State:OH
Mailing Address - Zip Code:43543
Mailing Address - Country:US
Mailing Address - Phone:419-485-4257
Mailing Address - Fax:419-485-3520
Practice Address - Street 1:306 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:OH
Practice Address - Zip Code:43543
Practice Address - Country:US
Practice Address - Phone:419-485-4257
Practice Address - Fax:419-485-3520
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2014-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3144152W00000X
OHT635152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH333526Medicaid
OHSA438003Medicare PIN
OH0235340001Medicare NSC
OH333526Medicaid