Provider Demographics
NPI:1033122411
Name:SEARS, ROBERT RUSSELL (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RUSSELL
Last Name:SEARS
Suffix:
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 1:207 BROOKSIDE DR
Mailing Address - Street 2:APT. C
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-1096
Mailing Address - Country:US
Mailing Address - Phone:330-364-3641
Mailing Address - Fax:
Practice Address - Street 1:1640 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654-8901
Practice Address - Country:US
Practice Address - Phone:330-674-3564
Practice Address - Fax:330-674-1630
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2881152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0361924Medicaid
OHSE0727731Medicare ID - Type Unspecified
OHU36264Medicare UPIN