Individual
DR. JAMES GERARD ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
6857 S PULASKI RD, CHICAGO, IL 60629-4151
(773) 767-5000
(773) 767-5176
Mailing address
6857 S PULASKI RD, CHICAGO, IL 60629-4151
(773) 767-5000
(773) 767-5176
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046008029
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
046008029
—
IL
01
—
08127171
BCBS OF IL
IL
Enumeration date
12/21/2006
Last updated
10/09/2008
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