=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881744969
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT S FELKER O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2007
-----------------------------------------------------
Last Update Date | 01/12/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 808 E WAKEFIELD AVE
-----------------------------------------------------
City | SIKESTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63801-5147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-472-2900
-----------------------------------------------------
Fax | 573-471-8384
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 808 E WAKEFIELD AVE
-----------------------------------------------------
City | SIKESTON
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63801-5147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-472-2900
-----------------------------------------------------
Fax | 573-471-8384
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | T02554
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------