Provider Demographics
NPI:1205107760
Name:JOEL ROFFER, O.D., LLC
Entity type:Organization
Organization Name:JOEL ROFFER, O.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROFFER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-678-8025
Mailing Address - Street 1:1600 S EAST RD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032-2610
Mailing Address - Country:US
Mailing Address - Phone:860-678-8025
Mailing Address - Fax:
Practice Address - Street 1:1600 S EAST RD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032-2610
Practice Address - Country:US
Practice Address - Phone:860-678-8025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-14
Last Update Date:2012-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT768152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT410000251OtherMEDICARE PTAN