Jeremy D. Roach, O.D., P.C.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2316 Issued in OK

Legal business name

JEREMY D. ROACH, O.D., P.C.

Practice address

113 N Broadway St
Stigler, OK 74462-2041

Phone

(918) 967-4424

Fax

(918) 967-2278

NPI assigned

Apr 17, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Jeremy D Roach, O.D.

Title

President Owner

Phone

(918) 967-4424

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277337600000",
    "number": "1174749386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 N BROADWAY ST",
            "city": "STIGLER",
            "state": "OK",
            "postal_code": "744622041",
            "telephone_number": "918-967-4424",
            "fax_number": "918-967-2278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 N BROADWAY ST",
            "city": "STIGLER",
            "state": "OK",
            "postal_code": "744622041",
            "telephone_number": "918-967-4424",
            "fax_number": "918-967-2278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEREMY D. ROACH, O.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-17",
        "last_updated": "2010-06-24",
        "status": "A",
        "authorized_official_last_name": "ROACH",
        "authorized_official_first_name": "JEREMY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT OWNER",
        "authorized_official_telephone_number": "918-967-4424",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OK",
            "license": "2316",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF OK",
            "identifier": "442900444003",
            "state": "OK"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100762800-A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Stigler, OK
• Providers in Stigler, OK by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.