Provider Demographics
NPI:1760451439
Name:PIERCE, ROBERT HOWARD JR (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:HOWARD
Last Name:PIERCE
Suffix:JR
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 1:116 KILLGORE RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-7084
Mailing Address - Country:US
Mailing Address - Phone:318-251-3626
Mailing Address - Fax:318-251-3330
Practice Address - Street 1:116 KILLGORE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-7084
Practice Address - Country:US
Practice Address - Phone:318-251-3626
Practice Address - Fax:318-251-3330
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-16
Last Update Date:2016-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1000-294T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1550418Medicaid
LA4B246CR66Medicare PIN
LAU74270Medicare UPIN
LA4B246C025Medicare PIN