Provider Demographics
NPI:1083664957
Name:ROBERT LOVE OD AND ASSOCIATES PA
Entity Type:Organization
Organization Name:ROBERT LOVE OD AND ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-323-1130
Mailing Address - Street 1:1331 S INTERNATIONAL PKWY
Mailing Address - Street 2:STE 1271
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-1405
Mailing Address - Country:US
Mailing Address - Phone:407-323-1130
Mailing Address - Fax:407-323-0979
Practice Address - Street 1:1331 S INTERNATIONAL PKWY
Practice Address - Street 2:STE 1271
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1405
Practice Address - Country:US
Practice Address - Phone:407-323-1130
Practice Address - Fax:407-323-0979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3365152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20927OtherBLUE CROSS BLUE SHIELD
FL1242470001OtherDME NUMBER
FL20927OtherBLUE CROSS BLUE SHIELD
FLU76298Medicare UPIN