Provider Demographics
NPI:1396783593
Name:TSAI, ROGER HORNG-JER (OD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:HORNG-JER
Last Name:TSAI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:HORNG
Other - Middle Name:JER
Other - Last Name:TSAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:119 GWYNEDD LEA DR
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-1920
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6 CAVALIER DR
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-4714
Practice Address - Country:US
Practice Address - Phone:215-542-3996
Practice Address - Fax:215-628-2757
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000319152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU82488Medicare UPIN