Provider Demographics
NPI:1942305818
Name:LLOYD, ROBERT JOHN (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:LLOYD
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 1:1200 KIRTS BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4899
Mailing Address - Country:US
Mailing Address - Phone:248-528-1981
Mailing Address - Fax:614-416-2105
Practice Address - Street 1:1200 KIRTS BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4899
Practice Address - Country:US
Practice Address - Phone:248-528-1981
Practice Address - Fax:614-416-2105
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0EG000607152W00000X
NYTUV005011152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400005751Medicare PIN