Individual
DR. RODGER DEAN ROBERTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
213 N MAIN ST, MOSCOW, ID 83843-2700
(208) 882-2932
(208) 882-8776
Mailing address
213 N MAIN ST, MOSCOW, ID 83843-2700
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-552
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
805042600
—
ID
Enumeration date
11/12/2006
Last updated
01/13/2012
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