MEDICARE: DR. GARY L ROBERTS 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	OEG000379	PA

General Provider Information

NPI Number	:	1598843815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY L ROBERTS OD

Provider Business Mailing Address
First Line	:	2035 KING DR
Second Line	:
City	:	HERMITAGE
State	:	PA
Zip	:	16148-2538
Country	:	US
Telephone Number	:	724-981-3010
Fax Number	:

Provider Business Practice Location Address
First Line	:	2151 SHENANGO VALLEY FWY
Second Line	:
City	:	HERMITAGE
State	:	PA
Zip	:	16148-2586
Country	:	US
Telephone Number	:	724-346-5516
Fax Number	:

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

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	07/08/2007

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