Organization
JEREMY D. ROACH, O.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JEREMY D ROACH O.D. (PRESIDENT OWNER)
(918) 967-4424
Entity
Organization
Contact information
Practice address
113 N BROADWAY ST, STIGLER, OK 74462-2041
(918) 967-4424
(918) 967-2278
Mailing address
113 N BROADWAY ST, STIGLER, OK 74462-2041
(918) 967-4424
(918) 967-2278
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2316
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100762800-A
—
OK
01
—
442900444003
BCBS OF OK
OK
Enumeration date
04/17/2007
Last updated
06/24/2010
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