Provider Demographics
NPI:1790749018
Name:SILVERS, BOB (OD)
Entity Type:Individual
Prefix:MR
First Name:BOB
Middle Name:
Last Name:SILVERS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:175 WALMART PLAZA DR STE 2
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:KY
Mailing Address - Zip Code:42633-7942
Mailing Address - Country:US
Mailing Address - Phone:606-340-3057
Mailing Address - Fax:606-340-9489
Practice Address - Street 1:175 WALMART PLAZA DR STE 2
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-7942
Practice Address - Country:US
Practice Address - Phone:606-340-3057
Practice Address - Fax:606-340-9489
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1731152W00000X
SC1386152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist