MEDICARE: DR. ROBERT KENNETH ORR OD

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	3377TG	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0645230001	OTHER		PALMETTO GBA MEDICARE DME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1487757795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT KENNETH ORR OD

Provider Business Mailing Address
First Line	:	1601 NORTH BRYAN AVE
Second Line	:
City	:	LAMES
State	:	TX
Zip	:	79331
Country	:	US
Telephone Number	:	806-872-3667
Fax Number	:	806-872-2533

Provider Business Practice Location Address
First Line	:	1601 NORTH BRYAN AVE
Second Line	:
City	:	LAMES
State	:	TX
Zip	:	79331
Country	:	US
Telephone Number	:	806-872-3667
Fax Number	:	806-872-2533

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	07/08/2007

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