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General NPI Number Information
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NPI Number | 1942499660
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Entity Type | Organization
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Legal Business Name | DAVID L ROBERTS O D P C
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Dates
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Enumeration Date | 10/18/2007
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Last Update Date | 07/29/2011
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Provider Practice Location Address
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Address Line | 2110 N BROADWAY ST
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City | POTEAU
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State | OK
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Zip | 74953-2501
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Country | US
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Telephone | 918-647-3284
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Fax | 918-647-3394
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Provider Business Mailing Address
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Address Line | PO BOX 829
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City | POTEAU
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State | OK
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Zip | 74953-0829
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Country | US
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Telephone | 918-647-3284
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Fax | 918-647-3394
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID L ROBERTS
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Credential | O.D.
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Telephone | 918-647-3284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 781
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 781
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License Number State | OK
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