Provider Demographics
NPI:1952962359
Name:LA ROCHE, RIPON W III (MD)
Entity Type:Individual
Prefix:DR
First Name:RIPON
Middle Name:W
Last Name:LA ROCHE
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 506
Mailing Address - Street 2:
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-0506
Mailing Address - Country:US
Mailing Address - Phone:434-392-9555
Mailing Address - Fax:434-392-1524
Practice Address - Street 1:1511 W 3RD ST
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-2649
Practice Address - Country:US
Practice Address - Phone:434-392-9555
Practice Address - Fax:434-392-1524
Is Sole Proprietor?:No
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0618002794152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist