Provider Demographics
NPI:1083685804
Name:SHARP, ROBERT H (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:H
Last Name:SHARP
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 1:4 W 5TH ST
Mailing Address - Street 2:PO BOX 249
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022-1244
Mailing Address - Country:US
Mailing Address - Phone:712-243-1965
Mailing Address - Fax:712-243-1966
Practice Address - Street 1:4 W 5TH ST
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022-1244
Practice Address - Country:US
Practice Address - Phone:712-243-1965
Practice Address - Fax:712-243-1966
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01653152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1142224Medicaid
IA0142224Medicaid
410014634Medicare PIN
IA0252060001Medicare NSC
IA14222Medicare PIN
IA1142224Medicaid
IAT00862Medicare UPIN