Provider Demographics
NPI:1659416022
Name:DICKEY, ROBERT CURTIS (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CURTIS
Last Name:DICKEY
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 1:901 MONTANA AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-1544
Mailing Address - Country:US
Mailing Address - Phone:310-451-5741
Mailing Address - Fax:310-395-0025
Practice Address - Street 1:901 MONTANA AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-1544
Practice Address - Country:US
Practice Address - Phone:310-451-5741
Practice Address - Fax:310-395-0025
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8218T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU17688Medicare UPIN