MEDICARE: DR. ROBERT W TAYLOR 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	OEG000786	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TA000063119	OTHER	PA	BLUE SHIELD

General Provider Information

NPI Number	:	1831186238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT W TAYLOR OD

Provider Business Mailing Address
First Line	:	109 CROSSROADS RD
Second Line	:	SUITE 108
City	:	SCOTTDALE
State	:	PA
Zip	:	15683-2458
Country	:	US
Telephone Number	:	724-220-2430
Fax Number	:	724-220-2431

Provider Business Practice Location Address
First Line	:	109 CROSSROADS RD
Second Line	:	SUITE 108
City	:	SCOTTDALE
State	:	PA
Zip	:	15683-2458
Country	:	US
Telephone Number	:	724-220-2430
Fax Number	:	724-220-2431

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	04/02/2014

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