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General NPI Number Information
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NPI Number | 1962528844
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Entity Type | Organization
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Legal Business Name | ROBERT & KIMBERLY MOLTER INC
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 01/07/2008
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Provider Practice Location Address
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Address Line | 1008 BRIDGE ST
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City | CHARLEVOIX
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State | MI
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Zip | 49720-1602
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Country | US
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Telephone | 231-547-7800
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Fax | 231-547-7874
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Provider Business Mailing Address
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Address Line | PO BOX 2027
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City | KALKASKA
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State | MI
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Zip | 49646-2027
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Country | US
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Telephone | 231-258-9781
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Fax | 231-258-0616
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT E MOLTER JR.
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Credential | OD
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Telephone | 231-258-9781
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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 | 4901003200
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License Number State | MI
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