Provider Demographics
NPI:1619192507
Name:BIRENBAUM, ROBERT MELVIN (O D)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MELVIN
Last Name:BIRENBAUM
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 BISHOP RD
Mailing Address - Street 2:SUITE D-14
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3632
Mailing Address - Country:US
Mailing Address - Phone:972-661-2853
Mailing Address - Fax:972-398-2029
Practice Address - Street 1:7200 BISHOP RD
Practice Address - Street 2:SUITE D-14
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3632
Practice Address - Country:US
Practice Address - Phone:972-661-2853
Practice Address - Fax:972-398-2029
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-16
Last Update Date:2013-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01925T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10647OtherSPECTERA
TX57995OtherSAFEGUARD
TXE26FOtherBCBS
TXTX1925OtherEYEMED
TXTX91959OtherVISIONBENEFITS OF AMERICA
TX751316040OtherVISION CARE PLAN
TX751316040OtherVISION CARE PLAN
TXTX91959OtherVISIONBENEFITS OF AMERICA
TX57995OtherSAFEGUARD
TXB22924Medicare UPIN