Provider Demographics
NPI:1558431593
Name:SUTTER, ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:SUTTER
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 1:3215 S PROVIDENCE RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203
Mailing Address - Country:US
Mailing Address - Phone:573-442-7528
Mailing Address - Fax:573-874-0698
Practice Address - Street 1:3215 S PROVIDENCE RD
Practice Address - Street 2:SUITE C
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-5507
Practice Address - Country:US
Practice Address - Phone:573-442-7528
Practice Address - Fax:573-874-0698
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT2401152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist