Organization
SIDNEY ROTH, O.D. INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAWRENCE JAY ROTH O.D. (PRES.)
(330) 633-9190
Entity
Organization
Contact information
Practice address
384 NORTHEAST AVE, TALLMADGE, OH 44278-1443
(330) 633-9190
(330) 633-6899
Mailing address
384 NORTHEAST AVE, TALLMADGE, OH 44278-1443
(330) 633-9190
(330) 633-6899
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3750
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0585862
—
OH
05
—
T48448
—
OH
Enumeration date
05/05/2008
Last updated
08/19/2008
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