Provider Demographics
NPI:1144202797
Name:DIGIROLAMO, MICHAEL JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:DIGIROLAMO
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 1:2685 CARDINAL RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-8810
Mailing Address - Country:US
Mailing Address - Phone:434-977-6377
Mailing Address - Fax:434-296-3100
Practice Address - Street 1:2685 CARDINAL RIDGE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-8810
Practice Address - Country:US
Practice Address - Phone:434-977-6377
Practice Address - Fax:434-296-3100
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-18
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000038152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0618000038OtherVIRGINIA - TPA OPTOMETRY LICENSE
VAMD0237607OtherDEA NUMBER
VAMD0237607OtherDEA NUMBER
VA410001319Medicare ID - Type UnspecifiedMEDICARE NUMBER
VAT1013Medicare UPIN