Healthcare Provider Details

I. General information

NPI: 1831179175
Provider Name (Legal Business Name): GEORGE L. ROBERTS O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E. MAIN STREET
SCHUYLKILL HAVEN PA
17972
US

IV. Provider business mailing address

100 E MAIN ST
SCHUYLKILL HAVEN PA
17972-1677
US

V. Phone/Fax

Practice location:
  • Phone: 570-385-2345
  • Fax: 570-385-2345
Mailing address:
  • Phone: 570-385-2345
  • Fax: 570-385-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOEG000046
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: