Provider Demographics
NPI:1508806977
Name:RAMMOHAN, ROOPAL G (OD)
Entity type:Individual
Prefix:DR
First Name:ROOPAL
Middle Name:G
Last Name:RAMMOHAN
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 DELAWARE AVE
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILL
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1180
Mailing Address - Country:US
Mailing Address - Phone:610-424-2020
Mailing Address - Fax:484-362-0099
Practice Address - Street 1:522 DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILL
Practice Address - State:PA
Practice Address - Zip Code:18015-1180
Practice Address - Country:US
Practice Address - Phone:610-424-2020
Practice Address - Fax:484-362-0099
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001516152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012133480001Medicaid
PA087167Medicare ID - Type Unspecified
PA1012133480001Medicaid