Provider Demographics
NPI:1013090893
Name:ARMSTRONG, C. ROGER (OD)
Entity Type:Individual
Prefix:
First Name:C.
Middle Name:ROGER
Last Name:ARMSTRONG
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 1:55 BROOKSBY VILLAGE WAY
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923
Mailing Address - Country:US
Mailing Address - Phone:978-777-9263
Mailing Address - Fax:978-777-6963
Practice Address - Street 1:WAL-MART VISION CENTER
Practice Address - Street 2:55 BROOKSBY VILLAGA WAY
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923
Practice Address - Country:US
Practice Address - Phone:978-777-9263
Practice Address - Fax:978-777-6963
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2428152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0351393Medicaid
MS0351393Medicaid
MAT95523Medicare UPIN