Provider Demographics
NPI:1790764769
Name:STAMM, ROBERT A (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:STAMM
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:PO BOX 1808
Mailing Address - Street 2:
Mailing Address - City:MC COOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-1808
Mailing Address - Country:US
Mailing Address - Phone:308-345-5800
Mailing Address - Fax:
Practice Address - Street 1:218 WEST D STREET
Practice Address - Street 2:
Practice Address - City:MC COOK
Practice Address - State:NE
Practice Address - Zip Code:69001-3739
Practice Address - Country:US
Practice Address - Phone:308-345-5800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1049152W00000X
KS1636152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS650981Medicare PIN
NE264987Medicare PIN
NE410025983Medicare PIN
NEE53829Medicare UPIN