Roger D. Fannin, Od, Psc

NPI #1114128667 in Grayson, Kentucky

Provider Information

NPI Number: 1114128667
Entity Type: Organization
Organization Name: Roger D. Fannin, Od, Psc
Primary Specialty: Optometrist
Enumeration Date: May 31, 2007
Last Updated: Apr 14, 2023

Practice Location

Address: 313 S CAROL MALONE BLVD
City: Grayson
State: Kentucky
ZIP Code: 41143-1357
Phone: (606) 474-7833

Authorized Official

Name: DR. ROGER D. FANNIN, OD
Title: PRESIDENT
Phone: (606) 474-7833

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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