Provider Demographics
NPI:1972505824
Name:KABBES, ROBERT M (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:M
Last Name:KABBES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:R
Other - Middle Name:MICHAEL
Other - Last Name:KABBES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2315 DERR RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2439
Mailing Address - Country:US
Mailing Address - Phone:937-399-3700
Mailing Address - Fax:937-399-3799
Practice Address - Street 1:2315 DERR RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2439
Practice Address - Country:US
Practice Address - Phone:937-399-3700
Practice Address - Fax:937-399-3799
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3473152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000011186OtherANTHEM
OH0467516Medicaid
T47906Medicare UPIN
OH0467516Medicaid
OH0538092Medicare PIN