Provider Demographics
NPI:1851312573
Name:BUCKINGHAM, ROBERT SCOTT (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SCOTT
Last Name:BUCKINGHAM
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 1:1310 CRAMER CIRCLE
Mailing Address - Street 2:PENNOCK 506
Mailing Address - City:BIG RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49307-2738
Mailing Address - Country:US
Mailing Address - Phone:231-591-2222
Mailing Address - Fax:231-591-3991
Practice Address - Street 1:1310 CRAMER CIRCLE
Practice Address - Street 2:PENNOCK 506
Practice Address - City:BIG RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49307-2738
Practice Address - Country:US
Practice Address - Phone:231-591-2222
Practice Address - Fax:231-591-3991
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002795152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIRB002795OtherBLUE CROSS
MIRB002795OtherBLUE CROSS
MIE47602044Medicare PIN
U88081Medicare UPIN