Provider Demographics
NPI:1760555254
Name:WRESCH, ROBERT RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RICHARD
Last Name:WRESCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:388 YPAO RD
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-3701
Mailing Address - Country:US
Mailing Address - Phone:671-646-8881
Mailing Address - Fax:671-648-2557
Practice Address - Street 1:388 YPAO RD
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-3701
Practice Address - Country:US
Practice Address - Phone:671-646-8881
Practice Address - Fax:671-648-2557
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM000934207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG25667OtherTHE MED BOARD OF CA
GUE94121Medicare UPIN
GUH0000BDSQGMedicare PIN