Provider Demographics
NPI:1679697874
Name:MIDDLETON, ROBERT ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALAN
Last Name:MIDDLETON
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 1:21673 STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-1812
Mailing Address - Country:US
Mailing Address - Phone:561-470-2310
Mailing Address - Fax:561-470-4874
Practice Address - Street 1:21673 STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1812
Practice Address - Country:US
Practice Address - Phone:561-470-2310
Practice Address - Fax:561-470-4874
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL0003027152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCV09375OtherSPECTERA
FL36373OtherDAVIS VISION
FL5614702310OtherVISION SERVICE PLAN
FLFL3027OtherEYEMED
FLCV09375OtherSPECTERA
FL5614702310OtherVISION SERVICE PLAN