Provider Demographics
NPI:1578503546
Name:TAYLOR, ROBERT B (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:TAYLOR
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:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:NORTH WILKESBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28659-0878
Mailing Address - Country:US
Mailing Address - Phone:336-838-2281
Mailing Address - Fax:336-667-3761
Practice Address - Street 1:826 C STREET
Practice Address - Street 2:
Practice Address - City:NORTH WILKESBORO
Practice Address - State:NC
Practice Address - Zip Code:28659
Practice Address - Country:US
Practice Address - Phone:336-838-2281
Practice Address - Fax:336-667-3761
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0930152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC09898OtherBLUE CROSS BLUE SHIELD
NC8909898Medicaid
NCU02902Medicare UPIN
NC09898OtherBLUE CROSS BLUE SHIELD
NC246242Medicare PIN