Provider Demographics
NPI:1033106737
Name:DUKE, ROGER A (OD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:A
Last Name:DUKE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4409 MANCHACA RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1603
Mailing Address - Country:US
Mailing Address - Phone:512-443-4317
Mailing Address - Fax:512-443-0882
Practice Address - Street 1:4409 MANCHACA RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1603
Practice Address - Country:US
Practice Address - Phone:512-443-4317
Practice Address - Fax:512-443-0882
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2775TG152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX82403QOtherBLUE CROSS BLUE SHIELD OF TEXAS
TX82403QOtherBLUE CROSS BLUE SHIELD OF TEXAS