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General NPI Number Information
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NPI Number | 1508929134
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Entity Type | Organization
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Legal Business Name | DR GEORGE T ROBERTS OPTOMETRIST PLLC
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 07/05/2012
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Provider Practice Location Address
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Address Line | 75 MAIN ST
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City | SIDNEY
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State | NY
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Zip | 13838-1138
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Country | US
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Telephone | 607-563-7551
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Fax | 607-563-2442
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Provider Business Mailing Address
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Address Line | 75 MAIN ST
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City | SIDNEY
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State | NY
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Zip | 13838-1138
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Country | US
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Telephone | 607-563-7551
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Fax | 607-563-2442
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MRS. KATHI J ROBERTS
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Credential |
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Telephone | 607-563-7551
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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 | TUV003200
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License Number State | NY
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