Provider Demographics
NPI:1578662524
Name:LEHRER, ROBERT J (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:LEHRER
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 1:30 CANAL STREET
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-1638
Mailing Address - Country:US
Mailing Address - Phone:845-856-1023
Mailing Address - Fax:845-856-0429
Practice Address - Street 1:30 CANAL STREET
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-1638
Practice Address - Country:US
Practice Address - Phone:845-856-1023
Practice Address - Fax:845-856-0429
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT0038911152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00512670Medicaid
NYC29061Medicare PIN
NY0864260001Medicare NSC
NYT81489Medicare UPIN