Provider Demographics
NPI:1043272966
Name:ROBIRDS, SCOTT ROLAND (OD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:ROLAND
Last Name:ROBIRDS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:225 LEAFWING CT
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4357
Mailing Address - Country:US
Mailing Address - Phone:770-740-8816
Mailing Address - Fax:678-415-2683
Practice Address - Street 1:11460 JOHNS CREEK PARKWAY
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30097-1556
Practice Address - Country:US
Practice Address - Phone:678-415-3830
Practice Address - Fax:678-415-2683
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT 000916152W00000X
MOT02447152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist