Provider Demographics
NPI:1407142441
Name:COLE, ROBERT DAVID JR (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DAVID
Last Name:COLE
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:488 W HOSPITAL RD
Mailing Address - Street 2:STE 1
Mailing Address - City:PAOLI
Mailing Address - State:IN
Mailing Address - Zip Code:47454-8808
Mailing Address - Country:US
Mailing Address - Phone:812-620-4339
Mailing Address - Fax:
Practice Address - Street 1:488 W HOSPITAL RD
Practice Address - Street 2:SUITE 1
Practice Address - City:PAOLI
Practice Address - State:IN
Practice Address - Zip Code:47454-8807
Practice Address - Country:US
Practice Address - Phone:812-723-4752
Practice Address - Fax:812-723-4753
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-28
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003673A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist