Provider Demographics
NPI:1205849882
Name:MOLTER, ROBERT E JR (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:MOLTER
Suffix:JR
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:PO BOX 12
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-0012
Mailing Address - Country:US
Mailing Address - Phone:231-487-0478
Mailing Address - Fax:
Practice Address - Street 1:882 M 72 NW
Practice Address - Street 2:
Practice Address - City:KALKASKA
Practice Address - State:MI
Practice Address - Zip Code:49646
Practice Address - Country:US
Practice Address - Phone:231-258-9781
Practice Address - Fax:231-258-0616
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003025152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900D065010OtherBLUE CROSS BLUE SHIELD
MIRM003025OtherSTATE LICENSE
MI410018558OtherRAILROAD
MI943292016Medicaid
MI0800300001OtherMEDICARE MATERIALS
MIMI3025OtherEYEMED
FLOPC2085OtherSTATE LICENSE
FLOPC2085OtherSTATE LICENSE
MIOM39690001Medicare ID - Type Unspecified
FLOPC2085OtherSTATE LICENSE