Basic Information
| Provider Information | |||||||||
| NPI: | 1891716148 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROHM | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | COLLIE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4325 GLENWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276124532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197824100 | ||||||||
| FaxNumber: | 9197879573 | ||||||||
| Practice Location | |||||||||
| Address1: | 4325 GLENWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276124532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9197824100 | ||||||||
| FaxNumber: | 9197879573 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2006 | ||||||||
| LastUpdateDate: | 04/30/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1124 | NC | Y | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 0908P | 01 | NC | BCBS INDIVIDUAL | OTHER | 5908669 | 05 | NC | MEDICAID |