Provider Demographics
NPI:1497936553
Name:PALMER, ROBERT M (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:PALMER
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 1:215 S STURGEON ST
Mailing Address - Street 2:STE A
Mailing Address - City:MONTGOMERY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63361-2558
Mailing Address - Country:US
Mailing Address - Phone:573-564-3877
Mailing Address - Fax:573-564-3515
Practice Address - Street 1:215 S STURGEON ST
Practice Address - Street 2:STE A
Practice Address - City:MONTGOMERY CITY
Practice Address - State:MO
Practice Address - Zip Code:63361-2558
Practice Address - Country:US
Practice Address - Phone:573-564-3877
Practice Address - Fax:573-564-3515
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-16
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO2346152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO108637OtherANTHEM BCBS
MOMO2346OtherEYEMED VISION CARE
MOMA1093001Medicare PIN
MOT42755Medicare UPIN