1659372696 NPI number — DR. ROBERT B AUSTIN O.D.

Table of content: DR. ROBERT B AUSTIN O.D. (NPI 1659372696)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659372696 NPI number — DR. ROBERT B AUSTIN O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AUSTIN
Provider First Name:
ROBERT
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659372696
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 174
Provider Second Line Business Mailing Address:
27 MAIN ST
Provider Business Mailing Address City Name:
VERGENNES
Provider Business Mailing Address State Name:
VT
Provider Business Mailing Address Postal Code:
05491-0174
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
802-877-2422
Provider Business Mailing Address Fax Number:
802-877-1124

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
27 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERGENNES
Provider Business Practice Location Address State Name:
VT
Provider Business Practice Location Address Postal Code:
05491-1113
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-877-2422
Provider Business Practice Location Address Fax Number:
802-877-1124
Provider Enumeration Date:
08/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  0300000292 , registered in the state of VT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: 56-005641 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000499771002 . This is a "BLUE SHIELD OF NE NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: RA1824 . This is a "UPSTATE NEW YORK MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: P00078950 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 00059239 . This is a "BLUECROSS BLUESHIELD OF VERMONT" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 01610168 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3002410 . This is a "MVP" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".
  • Identifier: 367 . This is a "DAVIS VISION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 42951 . This is a "DAVIS VISION" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 1013521 , issued by the state of ( VT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 781269 . This is a "MVP" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
  • Identifier: 9475823 . This is a "CIGNA" identifier , issued by the state of ( VT ) . This identifiers is of the category "OTHER".




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