Individual provider Active NPI

Alan Jay Roth, O.D.

  • Optometrist
  • Philadelphia, PA
National Provider Identifier
1962599944
Registry record updated Jun 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OEG000696 Issued in PA
Practice address
7636 City Ave
Philadelphia, PA 19151-2007
Phone
(215) 594-8622
Fax
(215) 473-8525
NPI assigned
Oct 9, 2006
Last updated
Jun 2, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 2, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OEG000696 PA Primary

Addresses

Primary practice location

7636 City Ave
Philadelphia, PA 19151-2007

Mailing address

700 Powder Mill LN
Wynnewood, PA 19096-4035
Phone (610) 642-0801

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OEG000696PAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Keystone Eye Associates, LLC Optometrist Past Accepting new patients
National Vision, Inc. Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1160352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780358400000",
    "number": "1962599944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 POWDER MILL LN",
            "city": "WYNNEWOOD",
            "state": "PA",
            "postal_code": "190964035",
            "telephone_number": "610-642-0801",
            "fax_number": "215-546-1943"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7636 CITY AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191512007",
            "telephone_number": "215-594-8622",
            "fax_number": "215-473-8525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "ALAN",
        "middle_name": "JAY",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-09",
        "last_updated": "2026-06-02",
        "certification_date": "2026-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG000696",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2026; 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.