Provider Demographics
NPI:1932286689
Name:ROTHBARD, ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:ROTHBARD
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 1:7211 HAVEN AVE
Mailing Address - Street 2:STE A
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-6064
Mailing Address - Country:US
Mailing Address - Phone:909-980-3535
Mailing Address - Fax:909-980-2684
Practice Address - Street 1:10598 BASELINE RD
Practice Address - Street 2:STE. B
Practice Address - City:ALTA LOMA
Practice Address - State:CA
Practice Address - Zip Code:91701-6330
Practice Address - Country:US
Practice Address - Phone:909-980-3535
Practice Address - Fax:909-980-2684
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2018-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA7326T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0073260Medicare ID - Type Unspecified
U71375Medicare UPIN