Provider Demographics
NPI:1407027733
Name:ROBERT A BISANAR O.D.
Entity Type:Organization
Organization Name:ROBERT A BISANAR O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR.
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:S
Authorized Official - Last Name:WINEBARGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-322-8052
Mailing Address - Street 1:PO BOX 1967
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28603-1967
Mailing Address - Country:US
Mailing Address - Phone:828-322-8052
Mailing Address - Fax:828-322-8053
Practice Address - Street 1:305 3RD AVE NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-4913
Practice Address - Country:US
Practice Address - Phone:828-322-8052
Practice Address - Fax:828-322-8053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0837332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909097Medicaid
NC0696080001Medicare NSC