Individual
DR. MICHAEL P ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1001 STURDY RD, VALPARAISO, IN 46383-4126
(219) 462-7173
(219) 462-7504
Mailing address
2401 VALLEY DR, VALPARAISO, IN 46383-2520
(219) 413-5100
(219) 465-9502
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
18002513
IN
152W00000X
Optometrist
Primary
18002513A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200853920
—
IN
Enumeration date
01/31/2007
Last updated
01/28/2019
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