MEDICARE: DR. ROBERT JAMES BLUMTHAL 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	046007512	IL
2	152WC0802X	Corneal and Contact Management Optometrist	046007512	IL
3	152WL0500X	Low Vision Rehabilitation Optometrist	046007512	IL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	410033847	OTHER	IL	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1578568077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT JAMES BLUMTHAL O.D.

Provider Business Mailing Address
First Line	:	2020 W ILES AVE
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-7015
Country	:	US
Telephone Number	:	217-698-3030
Fax Number	:	217-698-4728

Provider Business Practice Location Address
First Line	:	2020 W ILES AVE
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62704-4174
Country	:	US
Telephone Number	:	217-698-3030
Fax Number	:	217-698-3068

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

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	02/08/2017

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