Provider Demographics
NPI:1710188206
Name:DUKALSKIS, ROBERT
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:DUKALSKIS
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 1:725 SE MOSHER AVE
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-3959
Mailing Address - Country:US
Mailing Address - Phone:541-672-2124
Mailing Address - Fax:541-672-6261
Practice Address - Street 1:725 SE MOSHER AVE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-3959
Practice Address - Country:US
Practice Address - Phone:541-672-2124
Practice Address - Fax:541-672-6261
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR0212160001Medicare PIN