MEDICARE: ROBERT L. IRBY JR. 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	831	OK

General Provider Information

NPI Number	:	1942200969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT L. IRBY JR. OD

Provider Business Mailing Address
First Line	:	PO BOX 897
Second Line	:
City	:	HOLDENVILLE
State	:	OK
Zip	:	74848-0897
Country	:	US
Telephone Number	:	405-379-3610
Fax Number	:	405-379-2019

Provider Business Practice Location Address
First Line	:	121 W MAIN ST
Second Line	:
City	:	HOLDENVILLE
State	:	OK
Zip	:	74848-3229
Country	:	US
Telephone Number	:	405-379-3610
Fax Number	:	405-379-2019

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

Provider Enumeration Date	:	08/01/2005
Last Update Date	:	06/29/2009

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