Provider Demographics
NPI:1326036807
Name:DICKEY, ROBERT HARRY (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:HARRY
Last Name:DICKEY
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 1:1950 OLD GALLOWS RD STE 520
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3970
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:5710 W GATE CITY BLVD STE Q
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-7047
Practice Address - Country:US
Practice Address - Phone:336-856-8711
Practice Address - Fax:336-856-0498
Is Sole Proprietor?:No
Enumeration Date:2005-10-10
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC901152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89093KRMedicaid
NC89093KRMedicaid
T64776Medicare UPIN