Provider Demographics
NPI:1326164286
Name:PLATT, ROBERT L (DO,MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:PLATT
Suffix:
Gender:M
Credentials:DO,MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 ELLIOT ROAD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02632
Mailing Address - Country:US
Mailing Address - Phone:508-790-9700
Mailing Address - Fax:
Practice Address - Street 1:768 IYANOUGH ROAD
Practice Address - Street 2:PEARL VISION CENTER
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601
Practice Address - Country:US
Practice Address - Phone:508-790-9700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2358152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA00026975Medicaid
MA15995OtherHARVARD PILGRIM
MA60054OtherAETNA
MA0335479Medicaid
MA002358OtherTUFTS
MAW15352OtherBC-BS
MA60054OtherAETNA
MA182658Medicare ID - Type Unspecified