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General NPI Number Information
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NPI Number | 1851533111
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Entity Type | Organization
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Legal Business Name | RODABAUGH OPTICAL
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Dates
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Enumeration Date | 04/01/2009
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Last Update Date | 04/01/2009
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Provider Practice Location Address
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Address Line | 126 S MAIN ST
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City | HORSEHEADS
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State | NY
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Zip | 14845-2443
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Country | US
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Telephone | 607-739-9121
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Fax |
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Provider Business Mailing Address
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Address Line | 126 S MAIN ST
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City | HORSEHEADS
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State | NY
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Zip | 14845-2443
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Country | US
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Telephone | 607-739-9121
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TODD T RODABAUGH
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Credential |
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Telephone | 607-739-9121
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 005967
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License Number State | NY
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