MEDICARE: DR. ROBERT L FONTANA 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	OEG001078	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OEG001078	OTHER	PA	STATE LICENSE

General Provider Information

NPI Number	:	1447239637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT L FONTANA O.D.

Provider Business Mailing Address
First Line	:	1935 LINCOLN WAY
Second Line	:
City	:	WHITE OAK
State	:	PA
Zip	:	15131-2401
Country	:	US
Telephone Number	:	412-673-3010
Fax Number	:	412-673-7799

Provider Business Practice Location Address
First Line	:	1935 LINCOLN WAY
Second Line	:
City	:	WHITE OAK
State	:	PA
Zip	:	15131-2401
Country	:	US
Telephone Number	:	412-673-3010
Fax Number	:	412-673-7799

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

Provider Enumeration Date	:	01/16/2006
Last Update Date	:	03/07/2023

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