Provider Demographics
NPI:1326193210
Name:ROHM, TRUDY L (OD)
Entity type:Individual
Prefix:
First Name:TRUDY
Middle Name:L
Last Name:ROHM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1774 OLD BROOK RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22901-1265
Mailing Address - Country:US
Mailing Address - Phone:434-973-4270
Mailing Address - Fax:
Practice Address - Street 1:1114 EMMET ST N STE D
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-4841
Practice Address - Country:US
Practice Address - Phone:434-971-2020
Practice Address - Fax:434-295-1351
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601001210152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA009206060Medicaid
VA106329OtherANTHEM BC BS