MEDICARE: DAVID L ROBERTS 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	781	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	731508474953A001	OTHER	OK	TRICARE STANDARD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427045921
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID L ROBERTS O.D.

Provider Business Mailing Address
First Line	:	PO BOX 829
Second Line	:	POTEAU
City	:	POTEAU
State	:	OK
Zip	:	74953-0829
Country	:	US
Telephone Number	:	918-647-3284
Fax Number	:	918-647-3394

Provider Business Practice Location Address
First Line	:	2110 N BROADWAY ST
Second Line	:	POTEAU
City	:	POTEAU
State	:	OK
Zip	:	74953-2501
Country	:	US
Telephone Number	:	918-647-3284
Fax Number	:	918-647-3394

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

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	07/29/2011

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Directions to “ DAVID L ROBERTS O.D.” Practice Location

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