Provider Demographics
NPI:1629031810
Name:FLESCH, ROBERT ADOLPH (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ADOLPH
Last Name:FLESCH
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 1:4591 39TH ST S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33711-4411
Mailing Address - Country:US
Mailing Address - Phone:727-866-2020
Mailing Address - Fax:727-866-2020
Practice Address - Street 1:11212 PARK BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-4752
Practice Address - Country:US
Practice Address - Phone:727-344-7848
Practice Address - Fax:727-344-7952
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL000709152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLT85139Medicare UPIN
FL19940ZMedicare ID - Type Unspecified