MEDICARE: DR. JAMES J 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	1507	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	86635R0	OTHER	BC OF MN
6	0663440001	OTHER	DURABLE MED
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	214L1R0	OTHER	BC OF MN

General Provider Information

NPI Number	:	1700870037
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES J ROBERTS OD

Provider Business Mailing Address
First Line	:	709 1ST AVE S
Second Line	:	BOX 437
City	:	ESTHERVILLE
State	:	IA
Zip	:	51334-2352
Country	:	US
Telephone Number	:	712-362-5822
Fax Number	:	712-362-4213

Provider Business Practice Location Address
First Line	:	709 1ST AVE S
Second Line	:	BOX 437
City	:	ESTHERVILLE
State	:	IA
Zip	:	51334-2352
Country	:	US
Telephone Number	:	712-362-5822
Fax Number	:	712-362-4213

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

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	03/06/2014

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Directions to “ DR. JAMES J ROBERTS OD” Practice Location

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