NPIMap

Organization Active NPI

Mark Rodammer OD PC

  • Optometrist
  • Emporia, VA
National Provider Identifier
1104884477
Registry record updated Dec 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
MARK RODAMMER OD PC
Practice address
511 Belfield Dr
Emporia, VA 23847-1217
Phone
(252) 442-0802
Fax
(252) 442-2820
NPI assigned
May 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Tina M Burgess
Title
Credentialing Specialist
Phone
(252) 442-0802

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193200000X MULTI-SPECIALTY GROUP 152W00000X Primary

Addresses

Primary practice location

511 Belfield Dr
Emporia, VA 23847-1217

Mailing address

PO Box 7396
Rocky Mount, NC 27804
Phone (252) 442-0802

Other identifiers 3

IdentifierTypeStateIssuer
010285691MedicaidVA
010338352MedicaidVA
010320445MedicaidVA

Other names 1

  • Doctors Vision Center Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228953600000",
    "number": "1104884477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7396",
            "city": "ROCKY MOUNT",
            "state": "NC",
            "postal_code": "27804",
            "telephone_number": "252-442-0802",
            "fax_number": "252-442-2820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "511 BELFIELD DR",
            "city": "EMPORIA",
            "state": "VA",
            "postal_code": "238471217",
            "telephone_number": "252-442-0802",
            "fax_number": "252-442-2820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK RODAMMER OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-03",
        "last_updated": "2008-12-11",
        "status": "A",
        "authorized_official_last_name": "BURGESS",
        "authorized_official_first_name": "TINA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "252-442-0802"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010285691",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010338352",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010320445",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Doctors Vision Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Emporia, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.