Provider Demographics
NPI:1578688636
Name:ROBERTS-PHILPOTT EYE ASSOCIATES, PA
Entity Type:Organization
Organization Name:ROBERTS-PHILPOTT EYE ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BOB
Authorized Official - Middle Name:GENE
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:479-524-5161
Mailing Address - Street 1:960 S MOUNT OLIVE ST STE A
Mailing Address - Street 2:
Mailing Address - City:SILOAM SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:72761-4204
Mailing Address - Country:US
Mailing Address - Phone:479-524-5161
Mailing Address - Fax:479-524-8046
Practice Address - Street 1:960 S MOUNT OLIVE ST STE A
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-4204
Practice Address - Country:US
Practice Address - Phone:479-524-5161
Practice Address - Fax:479-524-8046
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR0642860001Medicare NSC