Provider Demographics
NPI:1518954932
Name:RICE, ROBERT TERRY (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:TERRY
Last Name:RICE
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 1:1342 E CHAPMAN AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831
Mailing Address - Country:US
Mailing Address - Phone:714-526-5515
Mailing Address - Fax:714-526-5384
Practice Address - Street 1:1342 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831
Practice Address - Country:US
Practice Address - Phone:714-526-5515
Practice Address - Fax:714-526-5384
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7319T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGSD001700OtherGRP MEDICAID #
CAWY061OtherGRP MEDICARE #
CASD0073190Medicaid
CASD0073190Medicaid
CAW0P7319AMedicare ID - Type Unspecified