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NPI Code Detail

MEDICARE: DR. MARK DAVID RODAMMER O.D.

MEDICARE: DR. MARK DAVID RODAMMER O.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1152W00000XOptometrist0618001308VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1189926OTHERVAANTHEM BCBS-WAYNESB PROV#
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1972561173
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARK DAVID RODAMMER O.D.
Provider Business Mailing Address
First Line : 2514 LANGHORNE RD
Second Line :
City : LYNCHBURG
State : VA
Zip : 24501-1602
Country : US
Telephone Number : 434-239-2800
Fax Number :
Provider Business Practice Location Address
First Line : 2514 LANGHORNE RD
Second Line :
City : LYNCHBURG
State : VA
Zip : 24501-1602
Country : US
Telephone Number : 434-239-2800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/04/2006
Last Update Date : 08/06/2012

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