Individual
DR. MARK DAVID RODAMMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618001308
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009235612
—
VA
05
—
010257468
—
VA
01
—
189926
ANTHEM BCBS-WAYNESB PROV#
VA
Enumeration date
05/04/2006
Last updated
08/06/2012
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