Provider Demographics
NPI:1467134502
Name:SOUDER, ROBERT
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:SOUDER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5414 SHESHEQUIN RD
Mailing Address - Street 2:
Mailing Address - City:ULSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18850-8328
Mailing Address - Country:US
Mailing Address - Phone:570-249-0942
Mailing Address - Fax:
Practice Address - Street 1:1887 ELMIRA ST
Practice Address - Street 2:
Practice Address - City:SAYRE
Practice Address - State:PA
Practice Address - Zip Code:18840-9249
Practice Address - Country:US
Practice Address - Phone:607-249-0942
Practice Address - Fax:570-888-0713
Is Sole Proprietor?:No
Enumeration Date:2023-08-07
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA252660156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician