Provider Demographics
NPI:1801116199
Name:RODMAN, BROOKS (OD)
Entity type:Individual
Prefix:DR
First Name:BROOKS
Middle Name:
Last Name:RODMAN
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 1:2020 COLUMBIA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-1737
Mailing Address - Country:US
Mailing Address - Phone:503-397-4911
Mailing Address - Fax:503-397-3986
Practice Address - Street 1:2020 COLUMBIA BLVD
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-1737
Practice Address - Country:US
Practice Address - Phone:503-397-4911
Practice Address - Fax:503-397-3986
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3367ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R160458Medicare PIN