MEDICARE: DR. CARL D ROBERTSON 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	292	NV

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	:	1659341782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARL D ROBERTSON O.D.

Provider Business Mailing Address
First Line	:	415 US HIGHWAY 95A S
Second Line	:	SUITE 101
City	:	FERNLEY
State	:	NV
Zip	:	89408-9007
Country	:	US
Telephone Number	:	775-575-1966
Fax Number	:	775-575-1967

Provider Business Practice Location Address
First Line	:	415 US HIGHWAY 95A S
Second Line	:	SUITE 101
City	:	FERNLEY
State	:	NV
Zip	:	89408-9007
Country	:	US
Telephone Number	:	775-575-1966
Fax Number	:	775-575-1967

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	06/10/2008

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