Provider Demographics
NPI:1629172366
Name:MACBETH, ROBERT ALEXANDER
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALEXANDER
Last Name:MACBETH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:172 ARMISTICE BLVD
Mailing Address - Street 2:
Mailing Address - City:PAWTUCKET
Mailing Address - State:RI
Mailing Address - Zip Code:02860-3219
Mailing Address - Country:US
Mailing Address - Phone:401-725-6868
Mailing Address - Fax:
Practice Address - Street 1:172 ARMISTICE BLVD
Practice Address - Street 2:
Practice Address - City:PAWTUCKET
Practice Address - State:RI
Practice Address - Zip Code:02860-3219
Practice Address - Country:US
Practice Address - Phone:401-725-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI304152W00000X
MA2143152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9009773Medicaid
RI201332OtherBLUE CHIP
RI2200197OtherU HEALTH
27917OtherNEIGHBORHOOD HEALTH PLAN
9523OtherNEIGHBORHOOD HEALTH PLAN
97738OtherBLUE CROSS
RI9009773Medicaid