Individual
DR. CARL J ROTH III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2800 11TH AVE S STE 14, GREAT FALLS, MT 59405-5263
(406) 455-2020
(406) 771-6816
Mailing address
2800 11TH AVE S STE 14, GREAT FALLS, MT 59405-5263
(406) 455-2020
(406) 771-6816
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
MT675
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000027131
BLUE CROSS BLUE SHIELD
MT
05
—
0000481219
—
MT
01
—
410042781
RAILROAD MEDICARE
—
01
—
MSF1137622
MONTANA STATE FUND
MT
Enumeration date
02/13/2006
Last updated
12/08/2022
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