Provider Demographics
NPI:1427542208
Name:ROEHM, MORGAN ELIZABETH JUDE (OD)
Entity Type:Individual
Prefix:DR
First Name:MORGAN
Middle Name:ELIZABETH JUDE
Last Name:ROEHM
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 1:3035 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14225-2661
Mailing Address - Country:US
Mailing Address - Phone:716-896-3351
Mailing Address - Fax:
Practice Address - Street 1:3035 GENESEE ST
Practice Address - Street 2:
Practice Address - City:CHEEKTOWAGA
Practice Address - State:NY
Practice Address - Zip Code:14225-2661
Practice Address - Country:US
Practice Address - Phone:716-896-3351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-15
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008794152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist