Provider Demographics
NPI:1497741730
Name:COLE, ROBERT M III (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:COLE
Suffix:III
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:205 LAUREL HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-3635
Mailing Address - Country:US
Mailing Address - Phone:856-455-5500
Mailing Address - Fax:856-455-5480
Practice Address - Street 1:205 LAUREL HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-3635
Practice Address - Country:US
Practice Address - Phone:856-455-5500
Practice Address - Fax:856-455-5480
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00347300152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1238001Medicaid
NJ410026194OtherRR MEDICARE
NJ521202DAUMedicare ID - Type Unspecified
NJ1238001Medicaid