Provider Demographics
NPI:1336611557
Name:SUNDERMAN, ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:SUNDERMAN
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 1:92 ALEXANDRIA PIKE
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-1729
Mailing Address - Country:US
Mailing Address - Phone:859-781-2000
Mailing Address - Fax:859-781-8122
Practice Address - Street 1:92 ALEXANDRIA PIKE
Practice Address - Street 2:
Practice Address - City:FORT THOMAS
Practice Address - State:KY
Practice Address - Zip Code:41075-1729
Practice Address - Country:US
Practice Address - Phone:859-781-2000
Practice Address - Fax:859-781-8122
Is Sole Proprietor?:No
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2116DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY2116OtherKY STATE LICENSE NUMBER