MEDICARE: ROBERT MOCKABEE LDO

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	156FX1800X	Optician	S3668	OH

General Provider Information

NPI Number	:	1275955643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT MOCKABEE LDO

Provider Business Mailing Address
First Line	:	4485 GLENVIEW RD
Second Line	:
City	:	WARRENSVILLE HEIGHTS
State	:	OH
Zip	:	44128-3529
Country	:	US
Telephone Number	:	216-645-8578
Fax Number	:

Provider Business Practice Location Address
First Line	:	4485 GLENVIEW RD
Second Line	:
City	:	WARRENSVILLE HEIGHTS
State	:	OH
Zip	:	44128-3529
Country	:	US
Telephone Number	:	216-645-8578
Fax Number	:

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

Provider Enumeration Date	:	01/20/2014
Last Update Date	:	01/20/2014

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