Basic Information
| Provider Information | |||||||||
| NPI: | 1326193210 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROHM | ||||||||
| FirstName: | TRUDY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1774 OLD BROOK RD | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229011265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349734270 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1114 EMMET ST N STE D | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTESVILLE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 229034841 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4349712020 | ||||||||
| FaxNumber: | 4342951351 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2007 | ||||||||
| LastUpdateDate: | 05/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 0601001210 | VA | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 009206060 | 05 | VA | MEDICAID | 106329 | 01 | VA | ANTHEM BC BS | OTHER |