Provider Demographics
NPI:1437135548
Name:CONDON, ROBERT M (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:CONDON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:95 CHAPEL ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3155
Mailing Address - Country:US
Mailing Address - Phone:781-762-9018
Mailing Address - Fax:781-762-8878
Practice Address - Street 1:95 CHAPEL ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3155
Practice Address - Country:US
Practice Address - Phone:781-762-9018
Practice Address - Fax:781-762-8878
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2215152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0399167Medicaid
MA22-00672OtherUNITED HEALTH CARE
MAW16102OtherBLUE CROSS BLUE SHIELD
MA152756OtherHARVARD PILGRIM HEALTH CA
MAW16102OtherBLUE CROSS BLUE SHIELD
MA118958Medicare ID - Type Unspecified