Provider Demographics
NPI:1932316890
Name:ROBERT F. BROOKS, O.D., P.S.C.
Entity Type:Organization
Organization Name:ROBERT F. BROOKS, O.D., P.S.C.
Other - Org Name:BROOKS EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:MORRIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:606-473-5322
Mailing Address - Street 1:PO BOX 723
Mailing Address - Street 2:
Mailing Address - City:GREENUP
Mailing Address - State:KY
Mailing Address - Zip Code:41144-0723
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1621 ASHLAND RD
Practice Address - Street 2:UNIT 3
Practice Address - City:GREENUP
Practice Address - State:KY
Practice Address - Zip Code:41144-1207
Practice Address - Country:US
Practice Address - Phone:606-473-5322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1643DT152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9624Medicare PIN
KY0214650001Medicare NSC