Provider Demographics
NPI:1336189570
Name:MARTINDALE, ROBERT B (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:B
Last Name:MARTINDALE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:PO BOX 2069
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47131-2069
Mailing Address - Country:US
Mailing Address - Phone:812-282-8269
Mailing Address - Fax:812-282-2214
Practice Address - Street 1:510 E LEWIS AND CLARK PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-1730
Practice Address - Country:US
Practice Address - Phone:812-282-8269
Practice Address - Fax:812-282-2214
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN18001523AB152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN424050Medicare PIN
IN0608510001Medicare NSC
INT34758Medicare UPIN