Provider Demographics
NPI:1124013453
Name:STROHECKER, ROBERT DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DAVID
Last Name:STROHECKER
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 1:8 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16933-1508
Mailing Address - Country:US
Mailing Address - Phone:570-662-3891
Mailing Address - Fax:570-662-3460
Practice Address - Street 1:8 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:PA
Practice Address - Zip Code:16933-1508
Practice Address - Country:US
Practice Address - Phone:570-662-3891
Practice Address - Fax:570-662-3460
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000261152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012514530002Medicaid
PA0012514530003Medicaid
PA0012514530002Medicaid