Provider Demographics
NPI:1912105370
Name:ROLAND, CASEY N (OD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:N
Last Name:ROLAND
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4409 EVANS TO LOCKS RD
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3603
Mailing Address - Country:US
Mailing Address - Phone:706-396-7671
Mailing Address - Fax:706-228-4692
Practice Address - Street 1:4409 EVANS TO LOCKS RD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3603
Practice Address - Country:US
Practice Address - Phone:706-396-7671
Practice Address - Fax:706-228-4692
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002397152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA286172120AMedicaid
GA202I414172Medicare PIN