Provider Demographics
NPI:1801887534
Name:MCCARTNEY, ROGER C (OD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:C
Last Name:MCCARTNEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:800 S 23RD ST
Mailing Address - Street 2:PO BOX 312
Mailing Address - City:ORD
Mailing Address - State:NE
Mailing Address - Zip Code:68862-1674
Mailing Address - Country:US
Mailing Address - Phone:308-728-3420
Mailing Address - Fax:308-728-5908
Practice Address - Street 1:1511 M ST
Practice Address - Street 2:
Practice Address - City:ORD
Practice Address - State:NE
Practice Address - Zip Code:68862-1428
Practice Address - Country:US
Practice Address - Phone:308-728-3229
Practice Address - Fax:308-728-5908
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE809152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE06726OtherBLUE CROSS BLUE SHIELD
NE1245308253OtherMEDICARE NSC
NE47063736300Medicaid
NE0382230001OtherDME MAC
NE47063736302Medicaid
NE098964OtherMEDICARE GROUP
NE0382230001OtherDME MAC
NE06726OtherBLUE CROSS BLUE SHIELD
NE47063736300Medicaid
NE47063736302Medicaid