Provider Demographics
NPI:1790810364
Name:PFOST, ROBERT ALAN (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALAN
Last Name:PFOST
Suffix:
Gender:M
Credentials:OD
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:A
Other - Last Name:PFOST
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:3205 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-2740
Mailing Address - Country:US
Mailing Address - Phone:510-444-0666
Mailing Address - Fax:510-463-2222
Practice Address - Street 1:3205 GRAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-2740
Practice Address - Country:US
Practice Address - Phone:510-444-0666
Practice Address - Fax:510-463-2222
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5316T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0053160Medicaid
CASD0053160Medicaid