Provider Demographics
NPI:1245780097
Name:ROOPAL G. RAMMOHAN OD LLC
Entity Type:Organization
Organization Name:ROOPAL G. RAMMOHAN OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROOPAL
Authorized Official - Middle Name:G
Authorized Official - Last Name:RAMMOHAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:484-358-8900
Mailing Address - Street 1:4785 CURLY HORSE DR
Mailing Address - Street 2:
Mailing Address - City:CENTER VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18034-8788
Mailing Address - Country:US
Mailing Address - Phone:484-358-8900
Mailing Address - Fax:
Practice Address - Street 1:3701 CORPORATE PKWY
Practice Address - Street 2:130B
Practice Address - City:CENTER VALLEY
Practice Address - State:PA
Practice Address - Zip Code:18034-8230
Practice Address - Country:US
Practice Address - Phone:484-526-7300
Practice Address - Fax:610-791-3107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001516302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA087167K9EMedicare PIN
PAV03252Medicare UPIN