Provider Demographics
NPI:1225195399
Name:MAUGER, ROBERT REYNOLDS (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:REYNOLDS
Last Name:MAUGER
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 1:120 PINE NEEDLE LN
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-5814
Mailing Address - Country:US
Mailing Address - Phone:407-774-9080
Mailing Address - Fax:407-774-9080
Practice Address - Street 1:120 PINE NEEDLE LN
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-5814
Practice Address - Country:US
Practice Address - Phone:407-774-9080
Practice Address - Fax:407-774-9080
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 1854152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19249Medicare ID - Type Unspecified
FLT93900Medicare UPIN