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General NPI Number Information
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NPI Number | 1356552053
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Entity Type | Organization
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Legal Business Name | ROBY OD AND ASSOCIATES PC
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 10/14/2009
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Provider Practice Location Address
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Address Line | 15437 BROADWAY AVE
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City | HARVEY
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State | IL
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Zip | 60426-3306
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Country | US
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Telephone | 708-331-4441
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Fax | 708-331-5520
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Provider Business Mailing Address
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Address Line | 15437 BROADWAY AVE
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City | HARVEY
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State | IL
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Zip | 60426-3306
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Country | US
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Telephone | 708-331-4441
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Fax | 708-331-5520
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHELE D. ROBY
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Credential | O.D.
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Telephone | 708-331-4441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046008239
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License Number State | IL
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