Provider Demographics
NPI:1548397623
Name:CONWAY, ROBERT M (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:CONWAY
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 1:20 ALLENS CREEK ROAD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-3228
Mailing Address - Country:US
Mailing Address - Phone:585-461-6225
Mailing Address - Fax:
Practice Address - Street 1:20 ALLENS CREEK RD
Practice Address - Street 2:SUITE 1
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3228
Practice Address - Country:US
Practice Address - Phone:585-461-6225
Practice Address - Fax:585-461-6228
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0039561152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist