Provider Demographics
NPI:1861996191
Name:ROGGY VISION CENTER, PLLC
Entity type:Organization
Organization Name:ROGGY VISION CENTER, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:ROGGY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:319-569-1936
Mailing Address - Street 1:708 5TH ST STE 1
Mailing Address - Street 2:
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2339
Mailing Address - Country:US
Mailing Address - Phone:319-569-1936
Mailing Address - Fax:319-483-6597
Practice Address - Street 1:708 5TH ST STE 1
Practice Address - Street 2:
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241
Practice Address - Country:US
Practice Address - Phone:319-331-2192
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-21
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA20114152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty