Provider Demographics
NPI:1902835556
Name:DIBBLE, ROBERT F (M D)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:F
Last Name:DIBBLE
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIMANTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06226-2014
Mailing Address - Country:US
Mailing Address - Phone:860-423-2111
Mailing Address - Fax:860-423-7559
Practice Address - Street 1:1120 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2014
Practice Address - Country:US
Practice Address - Phone:860-423-2111
Practice Address - Fax:860-423-7559
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT030376207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001303768Medicaid
CT08-04978OtherUNITED HEALTHCARE ID#
CT004215415Medicaid
CTWIS003OtherOXFORD PROVIDER #
CT050058OtherHEALTHNET PROVIDER ID
CT0122742OtherAETNA PROVIDER #
CT010030376CT01OtherANTHEM PROVIDER #
CT799860OtherCONNECTICARE PROV #
1217470001Medicare NSC
CT08-04978OtherUNITED HEALTHCARE ID#
CT0122742OtherAETNA PROVIDER #
CT004215415Medicaid
CT001303768Medicaid