NPIMap

Individual provider Active NPI

Michael Stuart Roth, O.D.

  • Optometrist
  • Rancho Mirage, CA
National Provider Identifier
1912954827
Registry record updated Apr 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
SOL6058 Issued in CA
Practice address
72057 Dinah Shore Dr
Suite D
Rancho Mirage, CA 92270-1791
Phone
(760) 340-3937
Fax
(760) 340-1940
NPI assigned
May 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X SOL6058 CA Primary

Addresses

Primary practice location

72057 Dinah Shore Dr
Suite D
Rancho Mirage, CA 92270-1791

Mailing address

72057 Dinah Shore Dr
Suite D
Rancho Mirage, CA 92270-1791
Phone (760) 340-3937

Other identifiers 2

IdentifierTypeStateIssuer
OVS09OtherNYBCBS
0250890001OtherNYDMERC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190611003301 NV Practitioner - Optometry 3173671047 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
SOL6058CAMDOptometrist
1001NVMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Girisgen & Kopolow OD, PC Optometrist CurrentSince Aug 4, 2019 Accepting new patients
Girisgen & Kopolow OD, PC Optometrist Current Accepting new patients
Girisgen & Kopolow OD, PC Optometrist CurrentSince Aug 4, 2019 Accepting new patients
Kopolow & Girisgen Professional Corporation Optometrist CurrentSince Aug 4, 2019 Accepting new patients
Sparks Family Hospital Inc Past Accepting new patients
Sunrise Mountainview Hospital, Inc. Past Accepting new patients
Centennial Hills Hospital Medical Center Past Accepting new patients
Prime Healthcare Services - Reno LLC Past Accepting new patients
South Lyon Health Center, Inc. Past Accepting new patients
Desert Springs Hospital Past Accepting new patients
Dignity Health Past Accepting new patients
Mt Grant General Hospital Past Accepting new patients
Milauskas Eye Institute Medical Group II Inc Optometrist Past Accepting new patients
Roth Vision Care, Doctor of Optometry, PLLC Optometrist PastSince Aug 20, 2007 Accepting new patients

Locations

75 S Valle Verde Dr
Ste 120
Henderson, NV 89012

4045 Spencer St
Ste A59
Las Vegas, NV 89119
Phone (702) 437-5521

2021 N Rainbow Blvd
Ste 100
Las Vegas, NV 89108
Phone (702) 529-3145

7361 W Lake Mead Blvd
Ste 104
Las Vegas, NV 89128
Phone (702) 341-7254

Interoperability endpoints

  • FHIR API: https://rothvision.ef.prod.fhir.ema-api.com/fhir/r4/

Organizations & group practices 15

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1365033600000",
    "number": "1912954827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "72057 DINAH SHORE DR",
            "address_2": "SUITE D",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922701791",
            "telephone_number": "760-340-3937",
            "fax_number": "760-340-1940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "72057 DINAH SHORE DR",
            "address_2": "SUITE D",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922701791",
            "telephone_number": "760-340-3937",
            "fax_number": "760-340-1940"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "MICHAEL",
        "middle_name": "STUART",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-27",
        "last_updated": "2013-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "SOL6058",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "OVS09",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DMERC",
            "identifier": "0250890001",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Mirage, CA

Sources for this page

Verify at the official NPI Registry.