Sidney Roth, O.D. Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

3750 Issued in OH

Legal business name

SIDNEY ROTH, O.D. INC.

Practice address

384 Northeast Ave
Tallmadge, OH 44278-1443

Phone

(330) 633-9190

Fax

(330) 633-6899

NPI assigned

May 5, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Lawrence Jay Roth, O.D.NPI 1215916887

Title

Pres.

Phone

(330) 633-9190

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Lawrence Jay Roth, O.D.

  • Optometrist
  • Tallmadge, OH
  • NPI 1215916887
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1209945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219104000000",
    "number": "1710153382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "384 NORTHEAST AVE",
            "city": "TALLMADGE",
            "state": "OH",
            "postal_code": "442781443",
            "telephone_number": "330-633-9190",
            "fax_number": "330-633-6899"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "384 NORTHEAST AVE",
            "city": "TALLMADGE",
            "state": "OH",
            "postal_code": "442781443",
            "telephone_number": "330-633-9190",
            "fax_number": "330-633-6899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SIDNEY ROTH, O.D. INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-05",
        "last_updated": "2008-08-19",
        "status": "A",
        "authorized_official_last_name": "ROTH",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "PRES.",
        "authorized_official_telephone_number": "330-633-9190",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "OH",
            "license": "3750",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0585862",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "T48448",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samantha L Shaw
• Shelter Care, Inc.
• Lawan Short
• Maxwell Shu
• Rodney F Siddall, DDS
• Gerald Albert Sikora
• Stephen Marc Silling, PHD
• Monica Sincel
• Lauren Skove
• Samantha Leigh Slate

• Optometrist in Tallmadge, OH
• Providers in Tallmadge, OH by specialty
• Optometrist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.