Healthcare Provider Details

I. General information

NPI: 1114911096
Provider Name (Legal Business Name): ROBERT G ARICK OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4625 SE DIXIE HWY
STUART FL
34997
US

IV. Provider business mailing address

4625 SE DIXIE HWY
STUART FL
34997
US

V. Phone/Fax

Practice location:
  • Phone: 772-286-1090
  • Fax: 772-286-1214
Mailing address:
  • Phone: 772-286-1090
  • Fax: 772-286-1214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC1257
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: