Marissa Emily Roderick, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1752 Issued in KS

Practice address

4600 W Kellogg Dr
Suite 215
Wichita, KS 67209-2568

Phone

(316) 943-0433

NPI assigned

Aug 4, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Miss Marissa Emily Krug Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Carla J Mosteller OD PA

  • Optometrist
  • Wichita, KS
  • NPI 1831274166
  NPD (past)
• Eye Associates of Wichita PA

  • Optometrist
  • Wichita, KS
  • NPI 1649355975
  NPD (past)
• Garden City Optometrists, P.a.

  • Optometrist
  • Garden City, KS
  • NPI 1386633923
  NPD (past)

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1508874280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9911 E 21ST ST N",
            "address_2": "APT 1307",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672063551",
            "telephone_number": "316-636-9551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4600 W KELLOGG DR",
            "address_2": "SUITE 215",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672092568",
            "telephone_number": "316-943-0433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODERICK",
        "first_name": "MARISSA",
        "middle_name": "EMILY",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-04",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "KS",
            "license": "1752",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARISSA",
            "last_name": "KRUG",
            "middle_name": "EMILY",
            "prefix": "MISS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• George Roccaforte, ENP
• Natalie Rockers
• Brent L Rockley, M.D.
• Susan Wright Rockley, DPT
• Rocky Mountain Holdings, LLC
• Rodolfo a Argosino MD PA
• Rebekah Rodriguez-Jimenez, MA CCC-SLP
• Bianca C Rodriguez, LMFT
• Biviana Rodriguez
• Christina Rodriguez, RN/BSN

• Optometrist in Wichita, KS
• Providers in Wichita, KS by specialty
• Optometrist in Kansas

• 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.

Verify at the official NPI Registry.