Provider Demographics
NPI:1427030519
Name:ROHLA, MICHAEL D (OD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:ROHLA
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 1:1118 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ARROYO GRANDE
Mailing Address - State:CA
Mailing Address - Zip Code:93420-2590
Mailing Address - Country:US
Mailing Address - Phone:805-489-5577
Mailing Address - Fax:805-489-2588
Practice Address - Street 1:1118 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420-2590
Practice Address - Country:US
Practice Address - Phone:805-489-5577
Practice Address - Fax:805-489-2588
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5756T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0057560Medicaid
CA953295965OtherBLUE CROSS
CA14270305965OtherCEN CAL
CASCWI0OtherTRICARE
CA0758990001Medicare NSC
CAOP5756Medicare ID - Type Unspecified
CASD0057560Medicaid