Glenn K. Roter, OD, a Professional Corporation

Primary specialty

OptometristTaxonomy code 152W00000X

License

NV 411 Issued in NV

Legal business name

GLENN K. ROTER, OD, A PROFESSIONAL CORPORATION

Practice address

5200 S Fort Apache Rd
Las Vegas, NV 89148-1722

Phone

(702) 368-0092

Fax

(702) 368-0097

NPI assigned

Nov 16, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Glenn K. Roter, O.D.NPI 1245316629

Title

President

Phone

(702) 368-0092

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Glenn K. Roter, O.D.

  • Optometrist
  • Las Vegas, NV
  • NPI 1245316629
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1289865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1289865600000",
    "number": "1053612424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5200 S FORT APACHE RD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891481722",
            "telephone_number": "702-368-0092",
            "fax_number": "702-368-0097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5200 S FORT APACHE RD",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891481722",
            "telephone_number": "702-368-0092",
            "fax_number": "702-368-0097"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENN K. ROTER, OD, A PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-16",
        "last_updated": "2010-11-16",
        "status": "A",
        "authorized_official_last_name": "ROTER",
        "authorized_official_first_name": "GLENN",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "702-368-0092",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NV",
            "license": "NV 411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Glee Health Medical Institute Nevada LLC
• Glen J Hime, M.D., PC
• Glen S Cochrane (East Desert Inn Wellness)
• Natasha Glenboski
• Glenn E. Hurst DDS a Professional Corporation (Hurst Family Dental)
• Delores Glenn-Lewis
• Maria Pualani Glenn-Sullivan
• Alisha Nicole Glenn
• Cheryl Yvonne Glenn, LPC
• Khalil Glenn

• Optometrist in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Optometrist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.