Provider Demographics
NPI:1942200969
Name:IRBY, ROBERT L JR (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:IRBY
Suffix:JR
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:PO BOX 897
Mailing Address - Street 2:
Mailing Address - City:HOLDENVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74848-0897
Mailing Address - Country:US
Mailing Address - Phone:405-379-3610
Mailing Address - Fax:405-379-2019
Practice Address - Street 1:121 W MAIN ST
Practice Address - Street 2:
Practice Address - City:HOLDENVILLE
Practice Address - State:OK
Practice Address - Zip Code:74848-3229
Practice Address - Country:US
Practice Address - Phone:405-379-3610
Practice Address - Fax:405-379-2019
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK831152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKOK401956Medicare PIN
OKP00708214Medicare PIN
T40514Medicare UPIN
OK0516590001Medicare NSC
OK6228450001Medicare NSC