Provider Demographics
NPI:1811959265
Name:ROGERS, STUART DOUGLAS (OD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:DOUGLAS
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 1:124 N WASHINGTON AVE
Mailing Address - Street 2:P.O. BOX 159
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-1800
Mailing Address - Country:US
Mailing Address - Phone:731-989-2711
Mailing Address - Fax:731-989-2778
Practice Address - Street 1:124 N WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:TN
Practice Address - Zip Code:38340-1800
Practice Address - Country:US
Practice Address - Phone:731-989-2711
Practice Address - Fax:731-989-2778
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-03
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT857152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3596038Medicaid
TN3596038Medicare ID - Type Unspecified
TN3596038Medicaid