Provider Demographics
NPI:1447788419
Name:ROEHM, KIRSTI ELLEN (OD)
Entity Type:Individual
Prefix:
First Name:KIRSTI
Middle Name:ELLEN
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 1:620 10TH ST N STE 2C
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1407
Mailing Address - Country:US
Mailing Address - Phone:727-824-7120
Mailing Address - Fax:727-824-8329
Practice Address - Street 1:620 10TH ST N STE 2C
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1407
Practice Address - Country:US
Practice Address - Phone:727-824-7120
Practice Address - Fax:727-824-8329
Is Sole Proprietor?:No
Enumeration Date:2017-06-02
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6578152W00000X
FLOPC5540152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist