Provider Demographics
NPI:1043691595
Name:ROCKY MOUNT EYE PA
Entity Type:Organization
Organization Name:ROCKY MOUNT EYE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:252-443-1006
Mailing Address - Street 1:450 JONES RD
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-8207
Mailing Address - Country:US
Mailing Address - Phone:252-443-1006
Mailing Address - Fax:252-937-8366
Practice Address - Street 1:450 JONES RD
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-8207
Practice Address - Country:US
Practice Address - Phone:252-443-1006
Practice Address - Fax:252-937-8366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-10
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCE880Medicare PIN