Provider Demographics
NPI:1811152689
Name:ROA, JOHN MURPHY (LIC OPTICIAN)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:MURPHY
Last Name:ROA
Suffix:
Gender:M
Credentials:LIC OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 E INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32724-4330
Mailing Address - Country:US
Mailing Address - Phone:386-736-8080
Mailing Address - Fax:386-736-8080
Practice Address - Street 1:104 E INDIANA AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32724-4330
Practice Address - Country:US
Practice Address - Phone:386-736-8080
Practice Address - Fax:386-736-8080
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician