Provider Demographics
NPI:1942244637
Name:POOLE, ROBERT A (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:POOLE
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 1:158 NORTHPORT AVE
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-6060
Mailing Address - Country:US
Mailing Address - Phone:207-338-2571
Mailing Address - Fax:207-338-3810
Practice Address - Street 1:158 NORTHPORT AVE
Practice Address - Street 2:
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6060
Practice Address - Country:US
Practice Address - Phone:207-338-2571
Practice Address - Fax:207-338-3810
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT828152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME118130000Medicaid
MEMM7620Medicare ID - Type UnspecifiedBELFAST OFFICE
MEMM7618Medicare ID - Type UnspecifiedROCKLAND OFFICE
ME118130000Medicaid