Provider Demographics
NPI:1710940382
Name:ROBERTS, STEVEN LOWELL (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:LOWELL
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 1:204 S 3RD ST
Mailing Address - Street 2:PO BOX 112
Mailing Address - City:LAURENS
Mailing Address - State:IA
Mailing Address - Zip Code:50554-1337
Mailing Address - Country:US
Mailing Address - Phone:712-845-4308
Mailing Address - Fax:712-845-4588
Practice Address - Street 1:204 S 3RD ST
Practice Address - Street 2:STE BOX 112
Practice Address - City:LAURENS
Practice Address - State:IA
Practice Address - Zip Code:50554-1337
Practice Address - Country:US
Practice Address - Phone:712-845-4308
Practice Address - Fax:712-845-4588
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1577152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAT00808Medicare UPIN
IA12945Medicare ID - Type Unspecified