Individual
ROGER L NOVACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1245 WILSHIRE BLVD, 380, LOS ANGELES, CA 90017-4810
(213) 483-8810
(213) 481-1503
Mailing address
1245 WILSHIRE BLVD, 380, LOS ANGELES, CA 90017-4810
(213) 483-8810
(213) 481-1503
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
G53779
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G537790
—
CA
01
—
W3452
MEDICARE PTAN
CA
Enumeration date
08/12/2005
Last updated
02/08/2017
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