Provider Demographics
NPI:1700870037
Name:ROBERTS, JAMES J (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:J
Last Name:ROBERTS
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 1:709 1ST AVE S
Mailing Address - Street 2:BOX 437
Mailing Address - City:ESTHERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:51334-2352
Mailing Address - Country:US
Mailing Address - Phone:712-362-5822
Mailing Address - Fax:712-362-4213
Practice Address - Street 1:709 1ST AVE S
Practice Address - Street 2:BOX 437
Practice Address - City:ESTHERVILLE
Practice Address - State:IA
Practice Address - Zip Code:51334-2352
Practice Address - Country:US
Practice Address - Phone:712-362-5822
Practice Address - Fax:712-362-4213
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1507152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9201620Medicaid
NE42137593300Medicaid
MN464223600Medicaid
IA0082651Medicaid
86635R0OtherBC OF MN
0663440001OtherDURABLE MED
IN200857740AMedicaid
214L1R0OtherBC OF MN
NE42137593300Medicaid
IN200857740AMedicaid
IA0082651Medicaid