Fannin, Roger D.
Fannin, Roger D. is an sole proprietor health care provider with primary practice located at 313 S Carol Malone Blvd , Grayson KY 41143-1357. He recently has 2 registered licenses in different health care specialties including Suppliers / Eyewear Supplier (Equipment, not the service), Eye and Vision Services Providers / Optometrist. Eye and Vision Services Providers / Optometrist is his primary health care specialty. Fannin, Roger D. can be contacted via phone (606) 474-7833.Contact Information
Primary practice address
313 S Carol Malone Blvd
Grayson KY 41143-1357
Phone: (606) 474-7833
Fax: (606) 474-3563
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Eyewear Supplier (Equipment, not the service) | 332H00000X | KY1018DT | Kentucky |
| Eye and Vision Services Providers / Optometrist | 152W00000X | 1018DT | Kentucky |
Profile Details
| NPI number | 1407857766 |
|---|---|
| LBN Legal business name | Fannin, Roger D. |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 9th, 2005 |
| Last updated | Apr 14th, 2023 - about last year |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1407857766 | NPPES |
| Kentucky | MEDICAID | 77010189 | |
| Kentucky | Other | 5965025 | |
| Kentucky | Other | 45775780 | |
| Kentucky | Other | 000000048519 | |
| Kentucky | Other | 611071677 | |
| Kentucky | Other | P00059060 | |
| Kentucky | Other | 2272760 |
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