Provider Demographics
NPI:1013046283
Name:DR. TRUDY L. ROHM & ASSOCS OPTOMETRISTS
Entity Type:Organization
Organization Name:DR. TRUDY L. ROHM & ASSOCS OPTOMETRISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRUDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROHM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:434-978-7750
Mailing Address - Street 1:2034 RIO HILL CTR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1150
Mailing Address - Country:US
Mailing Address - Phone:434-978-7750
Mailing Address - Fax:434-975-0822
Practice Address - Street 1:2034 RIO HILL CTR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1150
Practice Address - Country:US
Practice Address - Phone:434-978-7750
Practice Address - Fax:434-975-0822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601001210152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C02947Medicare ID - Type Unspecified