Provider Demographics
NPI:1356448419
Name:SEGOOL, ROBERT E (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:E
Last Name:SEGOOL
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 1:112 WINN ST
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01803-3109
Mailing Address - Country:US
Mailing Address - Phone:781-270-2345
Mailing Address - Fax:781-623-2444
Practice Address - Street 1:112 WINN ST
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-3109
Practice Address - Country:US
Practice Address - Phone:781-270-2345
Practice Address - Fax:781-623-2444
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2009-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4503152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6260180001Medicare NSC
MAAA43165Medicare UPIN
MAW17595Medicare UPIN
MAW16433Medicare UPIN