Provider Demographics
NPI:1982719274
Name:ROMANCHIK, ROGER (OPT)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:
Last Name:ROMANCHIK
Suffix:
Gender:M
Credentials:OPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HELLERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18055-1320
Mailing Address - Country:US
Mailing Address - Phone:610-838-7220
Mailing Address - Fax:610-838-7806
Practice Address - Street 1:1225 MAIN ST
Practice Address - Street 2:
Practice Address - City:HELLERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18055-1320
Practice Address - Country:US
Practice Address - Phone:610-838-7220
Practice Address - Fax:610-838-7806
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA83307368156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician