Individual
DR. ZACHARY D ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
3301 LAKE AVE, FORT WAYNE, IN 46805-5529
(260) 422-3937
(260) 424-6900
Mailing address
3301 LAKE AVE, FORT WAYNE, IN 46805-5529
(260) 422-3937
(260) 424-6900
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18003761A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201197920
—
IN
Enumeration date
08/29/2012
Last updated
03/02/2016
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