Healthcare Provider Details

I. General information

NPI: 1215912340
Provider Name (Legal Business Name): ROBERT A STEARNS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 MAIN ST
FARMINGDALE NY
11735-2619
US

IV. Provider business mailing address

255 MAIN ST
FARMINGDALE NY
11735-2619
US

V. Phone/Fax

Practice location:
  • Phone: 516-249-0052
  • Fax: 516-249-7000
Mailing address:
  • Phone: 516-249-0052
  • Fax: 516-249-7000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV0024591
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: