Provider Demographics
NPI:1922146331
Name:ROBERTS, DORTHEANNE J (OD)
Entity Type:Individual
Prefix:DR
First Name:DORTHEANNE
Middle Name:J
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:778 ARRAN CT
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-8410
Mailing Address - Country:US
Mailing Address - Phone:904-375-1426
Mailing Address - Fax:
Practice Address - Street 1:1911 WELLS RD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-1702
Practice Address - Country:US
Practice Address - Phone:904-215-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC4200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist