Provider Demographics
NPI:1972852820
Name:ROBERTS, COLBY D (OD)
Entity Type:Individual
Prefix:
First Name:COLBY
Middle Name:D
Last Name:ROBERTS
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 1:800 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELK CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73644-3414
Mailing Address - Country:US
Mailing Address - Phone:580-225-1980
Mailing Address - Fax:580-225-8648
Practice Address - Street 1:800 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ELK CITY
Practice Address - State:OK
Practice Address - Zip Code:73644-3414
Practice Address - Country:US
Practice Address - Phone:580-225-1980
Practice Address - Fax:580-225-8648
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2746152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist