Provider Demographics
NPI:1508131954
Name:PRINZI, ROBERT ALLAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALLAN
Last Name:PRINZI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 CEDAR LIGHT LN
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-6978
Mailing Address - Country:US
Mailing Address - Phone:843-280-8779
Mailing Address - Fax:843-280-6669
Practice Address - Street 1:90 CEDAR LIGHT LN
Practice Address - Street 2:
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-6978
Practice Address - Country:US
Practice Address - Phone:843-280-8779
Practice Address - Fax:843-280-6669
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301100350207R00000X, 207W00000X
SC40818207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC408188Medicaid