Roger William Studd, OD, MPH
Individual provider Active NPI Optometrist · Crownpoint, NM
NPI 1184140899 · NPPES record last updated Aug 15, 2017
Key facts
- NPI
- 1184140899
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 4901005089 (MI)
- Practice address
- Highway Junction 57, Route 9
Crownpoint, NM 87313 - Phone
- (505) 786-5291
- NPI assigned
- Aug 15, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in TX, NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20171012002938 | TX | Practitioner - Optometry | 6709151095 | Reassigns benefits to 1 organization |
| I20190906002530 | NY | Practitioner - Optometry | 6709151095 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4901005089 | MI | MD | Optometrist |
| 008682 | NY | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Empire Vision Center Inc | Optometrist | Current |
Accepting new patients |
| Empire Vision Center, Inc | Current |
Accepting new patients | |
| DHHS PHS Naihs Crownpoint Hospital | Current | Accepting new patients | |
| Thoreau Clinic | Current |
Accepting new patients | |
| Pueblo Pintado Clinic | Current | Accepting new patients |
Locations
2680 Delaware Ave
Ste C
Buffalo, NY 14216
Phone (716) 873-1241
560 Troy Schenectady Rd
#7
Latham, NY 12110
Phone (518) 783-0090
1930 South Rd
#105
Poughkeepsie, NY 12601
Phone (845) 298-3200
2590 W Ridge Rd
Rochester, NY 14626
Phone (585) 227-7150
2921 Erie Blvd E
Syracuse, NY 13224
Phone (315) 446-3145
Interoperability endpoints
- 36086@visionworks.emadirect.md
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901005089 | MI | Yes |
Addresses
Primary practice location
Highway Junction 57, Route 9
Crownpoint, NM 87313
Mailing address
PO Box 2073
Crownpoint, NM 87313-2073
Other providers in Crownpoint, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 15, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.