Provider Demographics
NPI:1104894088
Name:DUKE, ROBERT CHARLES (OD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CHARLES
Last Name:DUKE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 98
Mailing Address - Street 2:
Mailing Address - City:CATOOSA
Mailing Address - State:OK
Mailing Address - Zip Code:74015-0098
Mailing Address - Country:US
Mailing Address - Phone:918-266-3411
Mailing Address - Fax:918-266-3412
Practice Address - Street 1:2310 N HIGHWAY 66
Practice Address - Street 2:SUITE A
Practice Address - City:CATOOSA
Practice Address - State:OK
Practice Address - Zip Code:74015-2409
Practice Address - Country:US
Practice Address - Phone:918-266-3411
Practice Address - Fax:918-266-3412
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK934152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKT40428Medicare UPIN