Provider Demographics
NPI:1659372696
Name:AUSTIN, ROBERT B (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:AUSTIN
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:P.O. BOX 174
Mailing Address - Street 2:27 MAIN ST
Mailing Address - City:VERGENNES
Mailing Address - State:VT
Mailing Address - Zip Code:05491-0174
Mailing Address - Country:US
Mailing Address - Phone:802-877-2422
Mailing Address - Fax:802-877-1124
Practice Address - Street 1:27 MAIN ST
Practice Address - Street 2:
Practice Address - City:VERGENNES
Practice Address - State:VT
Practice Address - Zip Code:05491-1113
Practice Address - Country:US
Practice Address - Phone:802-877-2422
Practice Address - Fax:802-877-1124
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-01
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0300000292152W00000X
NY56-005641152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000499771002OtherBLUE SHIELD OF NE NY
NYRA1824OtherUPSTATE NEW YORK MEDICARE
NYP00078950OtherRAILROAD MEDICARE
VT00059239OtherBLUECROSS BLUESHIELD OF VERMONT
NY01610168Medicaid
VT3002410OtherMVP
NY367OtherDAVIS VISION
NY42951OtherDAVIS VISION
VT1013521Medicaid
NY781269OtherMVP
VT9475823OtherCIGNA
VTPTAN0001951Medicare PIN
U59331Medicare UPIN