Provider Demographics
NPI:1033109293
Name:HORNBERGER, ROBERT H JR (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
Last Name:HORNBERGER
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 MAIN ST UNIT 1203
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-1919
Mailing Address - Country:US
Mailing Address - Phone:716-863-4030
Mailing Address - Fax:716-883-9551
Practice Address - Street 1:902 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1493
Practice Address - Country:US
Practice Address - Phone:716-883-9550
Practice Address - Fax:716-883-9551
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV00A90A1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01086277Medicaid
NY01086277Medicaid
NY52257BMedicare ID - Type Unspecified