Provider Demographics
NPI:1871155663
Name:ROTHER, MEGAN ALLISON (OD)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ALLISON
Last Name:ROTHER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:WY
Mailing Address - Zip Code:82240-1517
Mailing Address - Country:US
Mailing Address - Phone:307-532-2060
Mailing Address - Fax:307-532-5710
Practice Address - Street 1:3726 AVENUE D
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4665
Practice Address - Country:US
Practice Address - Phone:308-635-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1521152W00000X
PAOEG003536152W00000X
WY436T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1521OtherSTATE OF NEBRASKA
WY1871155663Medicaid
WY436TOtherSTATE OF WYOMING
PAOEG003536OtherLICENSE