Basic Information
Provider Information
NPI: 1245780097
EntityType: 2
ReplacementNPI:  
OrganizationName: ROOPAL G. RAMMOHAN OD LLC
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
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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
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
302R00000XOEG001516PAY Managed Care OrganizationsHealth Maintenance Organization 

No ID Information.


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