Provider Demographics
NPI:1427038835
Name:TIERI, ROBERT MICHAEL (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MICHAEL
Last Name:TIERI
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:PO BOX 301
Mailing Address - Street 2:
Mailing Address - City:MAYNARD
Mailing Address - State:MA
Mailing Address - Zip Code:01754
Mailing Address - Country:US
Mailing Address - Phone:978-266-0017
Mailing Address - Fax:978-263-5700
Practice Address - Street 1:465 GREAT RD
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720
Practice Address - Country:US
Practice Address - Phone:978-266-0017
Practice Address - Fax:978-263-5700
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3015152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
W201575OtherCIGNA
MA0347299Medicaid
39879OtherDAVIS VISION
MA152084OtherHARVARD PILGRIM
MA702894OtherTUFTS
1007735OtherAETNA
1007735OtherUS HEALTHCARE
MAW15588OtherBLUE CROSS
W201575OtherCIGNA
202758Medicare ID - Type Unspecified