MEDICARE: ROBERT A POOLE OD

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	OPT828	ME

General Provider Information

NPI Number	:	1770761900
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT A POOLE OD

Provider Business Mailing Address
First Line	:	96 MAVERICK ST
Second Line	:
City	:	ROCKLAND
State	:	ME
Zip	:	04841-2440
Country	:	US
Telephone Number	:	207-596-6074
Fax Number	:	207-596-0833

Provider Business Practice Location Address
First Line	:	96 MAVERICK ST
Second Line	:
City	:	ROCKLAND
State	:	ME
Zip	:	04841-2440
Country	:	US
Telephone Number	:	207-596-6074
Fax Number	:	207-596-0833

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	ROBERT ALDEN POOLE
Credential	:	O.D.
Telephone Number	:	207-338-2571

Provider Enumeration Date	:	02/11/2008
Last Update Date	:	02/11/2008

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