Provider Demographics
NPI:1275955643
Name:MOCKABEE, ROBERT (LDO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MOCKABEE
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4485 GLENVIEW RD
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-3529
Mailing Address - Country:US
Mailing Address - Phone:216-645-8578
Mailing Address - Fax:
Practice Address - Street 1:4485 GLENVIEW RD
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-3529
Practice Address - Country:US
Practice Address - Phone:216-645-8578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-20
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS3668156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician