Provider Demographics
NPI:1346887676
Name:ROHAN, JACQUELINE (OD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:
Last Name:ROHAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238G TOLLAND TPKE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-5706
Mailing Address - Country:US
Mailing Address - Phone:860-646-2015
Mailing Address - Fax:860-400-5818
Practice Address - Street 1:238G TOLLAND TPKE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-5706
Practice Address - Country:US
Practice Address - Phone:860-646-2015
Practice Address - Fax:860-400-5818
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-05
Last Update Date:2020-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3140152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty