Provider Demographics
NPI:1518921436
Name:SCHOENBERG, ROBERT LESLEY (OD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LESLEY
Last Name:SCHOENBERG
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 1:1204 N GAREY AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3806
Mailing Address - Country:US
Mailing Address - Phone:909-622-1301
Mailing Address - Fax:909-623-6061
Practice Address - Street 1:1204 N GAREY AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3806
Practice Address - Country:US
Practice Address - Phone:909-622-1301
Practice Address - Fax:909-623-6061
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-17
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA7050T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0070500Medicaid
CASD0070500Medicaid