MEDICARE: MR. ARIC DAVID 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	OD60167669	WA

General Provider Information

NPI Number	:	1831403773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ARIC DAVID ROBERTSON O.D

Provider Business Mailing Address
First Line	:	5318 S CASCADE PL
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99337-4549
Country	:	US
Telephone Number	:	231-855-2132
Fax Number	:

Provider Business Practice Location Address
First Line	:	1321 N COLUMBIA CENTER BLVD
Second Line	:
City	:	KENNEWICK
State	:	WA
Zip	:	99336-7689
Country	:	US
Telephone Number	:	509-735-3022
Fax Number	:

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

Provider Enumeration Date	:	08/03/2010
Last Update Date	:	08/12/2010

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