Provider Demographics
NPI:1417472614
Name:STAUBLE, ROBERT EDWARD III (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWARD
Last Name:STAUBLE
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:524 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-2409
Mailing Address - Country:US
Mailing Address - Phone:215-372-0147
Mailing Address - Fax:215-372-0157
Practice Address - Street 1:524 S 2ND ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-2409
Practice Address - Country:US
Practice Address - Phone:215-372-0147
Practice Address - Fax:215-372-0157
Is Sole Proprietor?:No
Enumeration Date:2017-08-08
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003334152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist