Active NPI
Roger J Trudell, O.D.
- Optometrist
- Longmont, CO
National Provider Identifier
1447314703
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1188
- Practice address
- 412 Main St
Longmont, CO 80501-5535 - Phone
- (303) 651-6700
- NPI assigned
- Dec 21, 2006
- Reactivated
- May 9, 2018
- 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 | 1188 | CO | Primary |
Addresses
Primary practice location
412 Main St
Longmont, CO 80501-5535
Mailing address
2565 Tamarack Ave
Boulder, CO 80304-0990
Phone (303) 443-4093
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1188 | CO | MD | Counseling Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kevin C Cottrell OD, P C | Optometrist | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166659200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1525824000000",
"number": "1447314703",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2565 TAMARACK AVE",
"city": "BOULDER",
"state": "CO",
"postal_code": "803040990",
"telephone_number": "303-443-4093"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "412 MAIN ST",
"city": "LONGMONT",
"state": "CO",
"postal_code": "805015535",
"telephone_number": "303-651-6700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRUDELL",
"first_name": "ROGER",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-21",
"last_updated": "2018-05-09",
"deactivation_date": "2018-04-30",
"reactivation_date": "2018-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "CO",
"license": "1188",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Longmont, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.