Healthcare Provider Details

I. General information

NPI: 1093927261
Provider Name (Legal Business Name): ROBERT JOHN HUNZIKER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E WASHINGTON AVE
UNION GAP WA
98903
US

IV. Provider business mailing address

PO BOX 528
PROSSER WA
99350-0528
US

V. Phone/Fax

Practice location:
  • Phone: 509-248-1073
  • Fax:
Mailing address:
  • Phone: 509-973-1118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD00000778
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: