Provider Demographics
NPI:1558471631
Name:WILCOX, ROBERT MARTIN (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MARTIN
Last Name:WILCOX
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 1:56 N MAIN ST
Mailing Address - Street 2:SUITE 314
Mailing Address - City:FALL RIVER
Mailing Address - State:MA
Mailing Address - Zip Code:02720-2132
Mailing Address - Country:US
Mailing Address - Phone:508-676-8861
Mailing Address - Fax:508-676-8861
Practice Address - Street 1:56 N MAIN ST
Practice Address - Street 2:SUITE 314
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02720-2132
Practice Address - Country:US
Practice Address - Phone:508-676-8861
Practice Address - Fax:508-676-8861
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3277152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0353272Medicaid
T 59408Medicare UPIN
MA0353272Medicaid