MEDICARE: ROBERT W. TAYLOR

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	OEG000786	PA

General Provider Information

NPI Number	:	1306087408
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT W. TAYLOR

Provider Business Mailing Address
First Line	:	109 CROSSROADS RD
Second Line	:	SUITE 108
City	:	SCOTTDALE
State	:	PA
Zip	:	15683-2458
Country	:	US
Telephone Number	:	724-220-2430
Fax Number	:	724-220-2431

Provider Business Practice Location Address
First Line	:	109 CROSSROADS RD
Second Line	:	SUITE 108
City	:	SCOTTDALE
State	:	PA
Zip	:	15683-2458
Country	:	US
Telephone Number	:	724-220-2430
Fax Number	:	724-220-2431

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT W TAYLOR
Credential	:	OD
Telephone Number	:	724-220-2430

Provider Enumeration Date	:	03/19/2009
Last Update Date	:	03/19/2009

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