Active NPI
Thomas Barker Roth, OPTOMETRIST OD
- Optometrist
- Ann Arbor, MI
National Provider Identifier
1346380185
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4901002292
- Practice address
- 2500 Packard Rd
Ste #103
Ann Arbor, MI 48104-6827 - Phone
- (734) 973-1990
- NPI assigned
- Feb 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901002292 | MI | Primary |
Addresses
Primary practice location
2500 Packard Rd
Ste #103
Ann Arbor, MI 48104-6827
Mailing address
2500 Packard Rd
Ste #103
Ann Arbor, MI 48104-6827
Phone (734) 973-1990
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 90OH165310 | Other | MI | BLUE CROSS BLUE SHIELD MI |
| 5011007 | Medicaid | MI | |
| VLM0045 | Other | MI | MCARE MI HEALTH INS CO |
| 54OH10378 | Other | MI | BLUE CROSS BLUE SHIELD MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4901002292 | MI | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170892800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1346380185",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2500 PACKARD RD",
"address_2": "STE #103",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481046827",
"telephone_number": "734-973-1990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2500 PACKARD RD",
"address_2": "STE #103",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481046827",
"telephone_number": "734-973-1990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROTH",
"first_name": "THOMAS",
"middle_name": "BARKER",
"name_prefix": "Dr.",
"credential": "OPTOMETRIST OD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MI",
"license": "4901002292",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD MI",
"identifier": "90OH165310",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5011007",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MCARE MI HEALTH INS CO",
"identifier": "VLM0045",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD MI",
"identifier": "54OH10378",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ann Arbor, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.