Basic Information
Provider Information | |||||||||
NPI: | 1245780097 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ROOPAL G. RAMMOHAN OD LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4785 CURLY HORSE DR | ||||||||
Address2: |   | ||||||||
City: | CENTER VALLEY | ||||||||
State: | PA | ||||||||
PostalCode: | 180348788 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4843588900 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 3701 CORPORATE PKWY | ||||||||
Address2: | 130B | ||||||||
City: | CENTER VALLEY | ||||||||
State: | PA | ||||||||
PostalCode: | 180348230 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4845267300 | ||||||||
FaxNumber: | 6107913107 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/05/2016 | ||||||||
LastUpdateDate: | 10/05/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | RAMMOHAN | ||||||||
AuthorizedOfficialFirstName: | ROOPAL | ||||||||
AuthorizedOfficialMiddleName: | G | ||||||||
AuthorizedOfficialTitleorPosition: | OPTOMETRIST | ||||||||
AuthorizedOfficialTelephone: | 4843588900 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | O.D. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 302R00000X | OEG001516 | PA | Y |   | Managed Care Organizations | Health Maintenance Organization |   |
No ID Information.