Provider Demographics
NPI:1396707238
Name:ROGERS, JOHN D (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:ROGERS
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 1:2620 HURLEY WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-3789
Mailing Address - Country:US
Mailing Address - Phone:916-453-1111
Mailing Address - Fax:
Practice Address - Street 1:2620 HURLEY WAY
Practice Address - Street 2:SUITE A
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95864-3789
Practice Address - Country:US
Practice Address - Phone:916-453-1111
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7042T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0070420Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION
CAU33653Medicare UPIN