Individual
DR. JEREMY D. ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1505 E MAIN ST, STIGLER, OK 74462-2913
(918) 967-4424
(918) 967-2278
Mailing address
PO BOX 179, STIGLER, OK 74462-0179
(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
—
100762800A
—
OK
Enumeration date
06/26/2006
Last updated
03/24/2015
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