MEDICARE: DR. ROBERT T. SAMUEL 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	T02184	MO

General Provider Information

NPI Number	:	1639193758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT T. SAMUEL O.D.

Provider Business Mailing Address
First Line	:	8857 W 75TH ST
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66204-2206
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5601 NE ANTIOCH RD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64119-2302
Country	:	US
Telephone Number	:	816-453-7044
Fax Number	:	913-677-2477

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

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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