Individual provider Active NPI

William Robert Roscoe, O.D., PH.D.

  • Optometrist
  • Cleveland, OH
National Provider Identifier
1932102340
Registry record updated Feb 28, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
3370, T-103 Issued in OH
Practice address
2500 Metrohealth Dr
Cleveland, OH 44109-1900
Phone
(216) 778-5830
NPI assigned
May 31, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 28, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 3370, T-103 OH Primary

Addresses

Primary practice location

2500 Metrohealth Dr
Cleveland, OH 44109-1900

Mailing address

3041 Ravineview Cir
Stow, OH 44224-5543
Phone (330) 342-7777

Other identifiers 1

IdentifierTypeStateIssuer
0612715MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050711000700 OH Practitioner - Optometry 1658307715 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3370, T-103OHMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Lifecare Family Health and Dental Center, Inc Current Accepting new patients
The Metrohealth System CurrentSince Jan 2, 1998 Accepting new patients
Lifecare Family Health and Dental Center, Inc CurrentSince Aug 1, 2019 Accepting new patients
The Metrohealth System CurrentSince Jan 2, 1998 Accepting new patients
Lifecare Family Health and Dental Center, Inc CurrentSince Aug 1, 2019 Accepting new patients

Locations

408 9th St SW
Canton, OH 44707
Phone (330) 454-2000

2725 Lincoln St E
Canton, OH 44707
Phone (330) 454-2000

2500 Metrohealth Dr
Cleveland, OH 44109
Phone (216) 778-2348

4229 Pearl Rd
Cleveland, OH 44109
Phone (216) 459-6300

830 Amherst Rd NE
Massillon, OH 44646
Phone (330) 454-2000

Organizations & group practices 5

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": "1117497600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393545600000",
    "number": "1932102340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3041 RAVINEVIEW CIR",
            "city": "STOW",
            "state": "OH",
            "postal_code": "442245543",
            "telephone_number": "330-342-7777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 METROHEALTH DR",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441091900",
            "telephone_number": "216-778-5830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSCOE",
        "first_name": "WILLIAM",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "O.D., PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-31",
        "last_updated": "2014-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "OH",
            "license": "3370, T-103",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0612715",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.