Provider Demographics
NPI:1114911096
Name:ARICK, ROBERT G (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:ARICK
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 1:4625 SE DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997
Mailing Address - Country:US
Mailing Address - Phone:772-286-1090
Mailing Address - Fax:772-286-1214
Practice Address - Street 1:4625 SE DIXIE HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997
Practice Address - Country:US
Practice Address - Phone:772-286-1090
Practice Address - Fax:772-286-1214
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1257152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084875100Medicaid
T84078Medicare UPIN
FL084875100Medicaid