Basic Information
| Provider Information | |||||||||
| NPI: | 1437181781 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DR ROGER A HULME OD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3850 GRANT AVE STE 130 | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805388431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706675511 | ||||||||
| FaxNumber: | 9702925213 | ||||||||
| Practice Location | |||||||||
| Address1: | 2677 N TAFT AVE | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706675511 | ||||||||
| FaxNumber: | 9702925213 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 12/30/2017 | ||||||||
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| AuthorizedOfficialLastName: | HULME | ||||||||
| AuthorizedOfficialFirstName: | ROGER | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9706675511 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1220 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 001951048 | 01 | HIGHMARK BCBS | OTHER | 906772 | 01 | BLOCK VISION | OTHER | 906772107603 | 01 | CO | EYE SPECIALISTS | OTHER | 4534960 | 01 | AETNA | OTHER | 649971 | 01 | CO | ANTHEM | OTHER | 693852 | 01 | COVENTRY HEALTH CARE | OTHER | MH0145917 | 01 | CO | DEA | OTHER | 1220 | 01 | CO | STATE LICENSE | OTHER | 1528036829 | 01 | NPI TYPE 1 | OTHER | 410038740 | 01 | RAIL ROAD MEDICARE | OTHER | 693901 | 01 | CO | MEDICARE | OTHER | 99893 | 01 | WELLMARK BCBS | OTHER | 3633036 | 01 | CIGNA | OTHER | HU41113 | 01 | CO | ANTHEM | OTHER |