Provider Demographics
NPI:1780612598
Name:ROGERS, RICHARD N (OD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:N
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:P O BOX 1417
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-2050
Mailing Address - Country:US
Mailing Address - Phone:731-925-6225
Mailing Address - Fax:731-925-0235
Practice Address - Street 1:285 MAIN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372-2050
Practice Address - Country:US
Practice Address - Phone:731-925-6225
Practice Address - Fax:731-925-0235
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN0711152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4643007OtherCIGNA
TN2001861OtherBCBS
TN3594571Medicaid
TN4643007OtherCIGNA
TN2001861OtherBCBS
TN0725070001Medicare NSC