MEDICARE: DR. ROBERT L FLOOD O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4901002645	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	900A17622	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1356424840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT L FLOOD O.D.

Provider Business Mailing Address
First Line	:	1380 E NAPIER AVE
Second Line	:	SUITE 1
City	:	BENTON HARBOR
State	:	MI
Zip	:	49022
Country	:	US
Telephone Number	:	269-926-7277
Fax Number	:	269-925-9027

Provider Business Practice Location Address
First Line	:	2603 NILES AVE
Second Line	:	SUITE A
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-1954
Country	:	US
Telephone Number	:	269-926-7277
Fax Number	:	269-408-5764

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2006
Last Update Date	:	05/18/2010

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