Roger B Ethington, M..D.
Individual provider Active NPI Optometrist · Coolidge, AZ
NPI 1679545776 · NPPES record last updated Jul 30, 2020
Key facts
- NPI
- 1679545776
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- 552 (AZ)
- Practice address
- 371 W Central Ave
Coolidge, AZ 85128-4706 - Phone
- (520) 723-3000
- Fax
- (520) 723-5393
- NPI assigned
- Feb 2, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 552 | AZ | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southwestern Eye Center LTD | Past | Accepting new patients |
Interoperability endpoints
- roger.ethington.p20@direct.avp.nextgenshare.com
- roger.ethington.p11@direct.avp.nextgenshare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 552 | AZ | Yes |
Addresses
Primary practice location
371 W Central Ave
Coolidge, AZ 85128-4706
Mailing address
4800 N 22ND St Ste 210
Phoenix, AZ 85016-4963
Phone (480) 892-8400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 034273 | Medicaid | AZ |
Other providers in Coolidge, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 30, 2020. 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.