Healthcare Provider Details

I. General information

NPI: 1538154646
Provider Name (Legal Business Name): ROBERT S CONSOR OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2005
Last Update Date: 10/23/2025
Certification Date: 10/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5494 GLEN LAKES DR
DALLAS TX
75231-4308
US

IV. Provider business mailing address

PO BOX 200438
DALLAS TX
75320-0438
US

V. Phone/Fax

Practice location:
  • Phone: 214-692-6220
  • Fax: 214-696-1579
Mailing address:
  • Phone: 817-784-0222
  • Fax: 817-467-5819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2227
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number2227TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: