Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3477 | MN |
NPI | 1013366400 |
---|---|
Provider Name | Dr. Christopher John Roghair |
First Address | Minneapolis, MN 55403-2309 |
Second Address | Rogers, MN 55374-9627 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2016 |
Last Update Date | 17/03/2018 |