Provider Demographics
NPI:1699764886
Name:FLOM, ROANNE ELAINE (OD)
Entity type:Individual
Prefix:DR
First Name:ROANNE
Middle Name:ELAINE
Last Name:FLOM
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 1:2386 DORSET RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-3146
Mailing Address - Country:US
Mailing Address - Phone:614-486-1733
Mailing Address - Fax:
Practice Address - Street 1:OSU COLLEGE OF OPTOMETRY
Practice Address - Street 2:338 W. 10TH AVE.
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210
Practice Address - Country:US
Practice Address - Phone:614-688-3337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4644152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00232788OtherRAILROAD MEDICARE, PART B
OHP00232788OtherRAILROAD MEDICARE, PART B
OHFL0791551Medicare ID - Type Unspecified