Provider Demographics
NPI:1245223965
Name:ROBERTS, GEORGE TEMPLETON (OD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:TEMPLETON
Last Name:ROBERTS
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 1:3455 VESTAL PKWY E
Mailing Address - Street 2:
Mailing Address - City:VESTAL
Mailing Address - State:NY
Mailing Address - Zip Code:13850-2147
Mailing Address - Country:US
Mailing Address - Phone:607-722-2020
Mailing Address - Fax:607-722-3937
Practice Address - Street 1:3455 VESTAL PKWY E
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-2147
Practice Address - Country:US
Practice Address - Phone:607-722-2020
Practice Address - Fax:607-722-3937
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-28
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV 003200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00545368Medicaid
NY00545368Medicaid
NYT89549Medicare UPIN