Provider Demographics
NPI:1225100399
Name:ROBERT E TITCOMB OD PC
Entity Type:Organization
Organization Name:ROBERT E TITCOMB OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:TITCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-460-3688
Mailing Address - Street 1:1020 INDEPENDENCE BLVD, SUITE 307
Mailing Address - Street 2:HAYGOOD MEDICAL CENTER
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-5543
Mailing Address - Country:US
Mailing Address - Phone:757-460-3688
Mailing Address - Fax:757-460-5516
Practice Address - Street 1:1020 INDEPENDENCE BLVD, SUITE 307
Practice Address - Street 2:HAYGOOD MEDICAL CENTER
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5543
Practice Address - Country:US
Practice Address - Phone:757-460-3688
Practice Address - Fax:757-460-5516
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA06180000523152W00000X
VA0618000523152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2923OtherDAVIS VISION
VA300065OtherSENTARA
VA352348626OtherVISION SERVICE PLAN
VA061152OtherANTHEM
VA009204008Medicaid
VA07124OtherSPECTERA
VA111661OtherEYEMED
VA2923OtherDAVIS VISION
VA07124OtherSPECTERA
VA=========OtherHUMANA GOLD
VA009204008Medicaid
VA111661OtherEYEMED
VA=========OtherTRICARE
VA=========OtherMAILHANDLERS