Provider Demographics
NPI:1932158094
Name:ROGERS, THOMAS PATRICK (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PATRICK
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 1:3064 COCHRAN ST
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-2772
Mailing Address - Country:US
Mailing Address - Phone:805-527-1700
Mailing Address - Fax:805-527-6122
Practice Address - Street 1:3064 COCHRAN ST
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-2772
Practice Address - Country:US
Practice Address - Phone:805-527-1700
Practice Address - Fax:805-527-6122
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 6334 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACL627BMedicare PIN
CAV37348Medicare UPIN