Provider Demographics
NPI:1881784585
Name:RODNEY L. IMMERMAN, O.D.
Entity type:Organization
Organization Name:RODNEY L. IMMERMAN, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:LANE
Authorized Official - Last Name:IMMERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:617-698-6700
Mailing Address - Street 1:389 CANTON AVE
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-3332
Mailing Address - Country:US
Mailing Address - Phone:617-698-6700
Mailing Address - Fax:617-698-5123
Practice Address - Street 1:1900 CROWN COLONY DR
Practice Address - Street 2:SUITE 301
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-0931
Practice Address - Country:US
Practice Address - Phone:617-770-4400
Practice Address - Fax:617-471-5093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA3103152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Single Specialty