Provider Demographics
NPI:1275504037
Name:DR. ROBERT H. SHARP, PC
Entity Type:Organization
Organization Name:DR. ROBERT H. SHARP, PC
Other - Org Name:FAMILY VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:712-243-1965
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:IA
Mailing Address - Zip Code:50022-0249
Mailing Address - Country:US
Mailing Address - Phone:712-243-1965
Mailing Address - Fax:712-243-1965
Practice Address - Street 1:4 W 5TH ST
Practice Address - Street 2:
Practice Address - City:ATLANTIC
Practice Address - State:IA
Practice Address - Zip Code:50022-1244
Practice Address - Country:US
Practice Address - Phone:712-243-1965
Practice Address - Fax:712-243-1965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0745463Medicaid
IA0745463Medicaid
IAI9159Medicare PIN
410014634Medicare PIN