Provider Demographics
NPI:1306194394
Name:ROBERT MAHER MD ROBERT DAVIS MD ET AL
Entity Type:Organization
Organization Name:ROBERT MAHER MD ROBERT DAVIS MD ET AL
Other - Org Name:SPOKANE OPTICAL COMPANY LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:K
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-456-0107
Mailing Address - Street 1:12525 E MISSION AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-1063
Mailing Address - Country:US
Mailing Address - Phone:509-924-7271
Mailing Address - Fax:509-928-7802
Practice Address - Street 1:12525 E MISSION AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-1063
Practice Address - Country:US
Practice Address - Phone:509-924-7271
Practice Address - Fax:509-928-7802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-22
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602617024332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
0292200001Medicare NSC