Individual
RODNEY L. IMMERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1900 CROWN COLONY DR, SUITE 301, QUINCY, MA 02169-0979
(617) 698-6700
(617) 698-5123
Mailing address
13 FORT ST, FAIRHAVEN, MA 02719-2757
(617) 698-6700
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3103
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0353922
—
MA
01
—
158263
HPHC
MA
01
—
763497
TUFTS
MA
01
—
W15692
BCBS
MA
01
—
W20420
BCBS GROUP
MA
01
—
W22043
SRA
MA
Enumeration date
09/30/2005
Last updated
04/28/2017
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