Provider Demographics
NPI:1881670446
Name:STAPLES, ROBERT LINDSAY (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LINDSAY
Last Name:STAPLES
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 1:1704 11TH ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-5020
Mailing Address - Country:US
Mailing Address - Phone:940-723-1274
Mailing Address - Fax:
Practice Address - Street 1:1704 11TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-5020
Practice Address - Country:US
Practice Address - Phone:940-723-1274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-15
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4717TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093488701Medicaid
TX305257301Medicaid
U33405Medicare UPIN
TX305257301Medicaid
TX093488701Medicaid