Provider Demographics
NPI:1376587253
Name:MORRISON, ROBERT ROYSTON
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ROYSTON
Last Name:MORRISON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:FOREST CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50436-0370
Mailing Address - Country:US
Mailing Address - Phone:641-585-3590
Mailing Address - Fax:641-585-4058
Practice Address - Street 1:139 EAST K STREET
Practice Address - Street 2:
Practice Address - City:FOREST CITY
Practice Address - State:IA
Practice Address - Zip Code:50436-1501
Practice Address - Country:US
Practice Address - Phone:641-585-3590
Practice Address - Fax:641-585-4058
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1505T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0083535Medicaid
08353Medicare PIN
IAT00658Medicare UPIN
IA0083535Medicaid