Provider Demographics
NPI:1407870645
Name:DYER, ROBERT E (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:DYER
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 1:101 APPLE VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-4725
Mailing Address - Country:US
Mailing Address - Phone:816-331-9590
Mailing Address - Fax:816-331-9591
Practice Address - Street 1:101 APPLE VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-4725
Practice Address - Country:US
Practice Address - Phone:816-331-9590
Practice Address - Fax:816-331-9591
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2011-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO 2309152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA2901002OtherMEDICARE PTAN
MOT 42506Medicare UPIN
MOP541975Medicare ID - Type Unspecified