Provider Demographics
NPI:1154497683
Name:HODES, ROBERT L (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:HODES
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 1:6080 STEUBENVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:MC KEES ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15136-1398
Mailing Address - Country:US
Mailing Address - Phone:412-787-2666
Mailing Address - Fax:412-787-3415
Practice Address - Street 1:6080 STEUBENVILLE PIKE
Practice Address - Street 2:
Practice Address - City:MC KEES ROCKS
Practice Address - State:PA
Practice Address - Zip Code:15136-1398
Practice Address - Country:US
Practice Address - Phone:412-787-2666
Practice Address - Fax:412-787-3415
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000489152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT29399Medicare UPIN
PA0731850001Medicare NSC
PA130866Medicare PIN