Healthcare Provider Details

I. General information

NPI: 1275504037
Provider Name (Legal Business Name): DR. ROBERT H. SHARP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 W 5TH ST
ATLANTIC IA
50022-1244
US

IV. Provider business mailing address

PO BOX 249
ATLANTIC IA
50022-0249
US

V. Phone/Fax

Practice location:
  • Phone: 712-243-1965
  • Fax: 712-243-1965
Mailing address:
  • Phone: 712-243-1965
  • Fax: 712-243-1965

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT H SHARP
Title or Position: GENERAL PARTNER
Credential: O.D.
Phone: 712-243-1965