Provider Demographics
NPI:1629131057
Name:OSBORN, ROBERT RAY (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RAY
Last Name:OSBORN
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 1:500 JUNIPER STREET
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951
Mailing Address - Country:US
Mailing Address - Phone:215-536-5583
Mailing Address - Fax:215-586-8640
Practice Address - Street 1:500 JUNIPER STREET
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951
Practice Address - Country:US
Practice Address - Phone:215-536-5583
Practice Address - Fax:215-586-8640
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE0007592T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOE0009592TOtherLICENSE #
U65241Medicare UPIN
752941Medicare ID - Type Unspecified