Provider Demographics
NPI:1295427870
Name:ROLLER, TIFFANIE T (OD)
Entity type:Individual
Prefix:
First Name:TIFFANIE
Middle Name:T
Last Name:ROLLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:TIFFANIE
Other - Middle Name:
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1716 W SADDLEBROOK LN APT SUITE
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8400
Mailing Address - Country:US
Mailing Address - Phone:479-531-0585
Mailing Address - Fax:
Practice Address - Street 1:3689 N STEELE BLVD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5347
Practice Address - Country:US
Practice Address - Phone:479-521-2555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2869152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist