Organization
GARY A. ROACH, O.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY ARTHUR ROACH O.D. (PRESIDENT)
(704) 663-3924
Entity
Organization
Contact information
Practice address
404 E CENTER AVE, MOORESVILLE, NC 28115-2544
(704) 663-3924
(704) 663-7057
Mailing address
404 E CENTER AVE, MOORESVILLE, NC 28115-2544
(704) 663-3924
(704) 663-7057
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
863
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
018TF
BCBS
NC
01
—
15906
PARTNERS MEDICARE CHOICE
NC
01
—
2209268
UNITED HEALTHCARE
NC
05
—
5906031
—
NC
01
—
DG1209
MEDICARE RAILROAD
NC
Enumeration date
08/02/2006
Last updated
02/14/2008
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