MEDICARE: DR. ROBERT L. DAVIS O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	046007176	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	506370	OTHER	IL	MEDICARE GROUP NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1265621361	OTHER	IL	GROUP NPI NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275513509
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT L. DAVIS O.D.

Provider Business Mailing Address
First Line	:	4663 W 95TH ST
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-2540
Country	:	US
Telephone Number	:	708-636-0600
Fax Number	:	708-636-0606

Provider Business Practice Location Address
First Line	:	4663 W 95TH ST
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-2540
Country	:	US
Telephone Number	:	708-636-0600
Fax Number	:	708-636-0606

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	07/01/2025

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