Provider Demographics
NPI:1356409221
Name:AMIEL, ROBERT KEITH (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KEITH
Last Name:AMIEL
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 1:36 NE EGLIN PARKWAY
Mailing Address - Street 2:
Mailing Address - City:FT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548
Mailing Address - Country:US
Mailing Address - Phone:850-243-3111
Mailing Address - Fax:850-244-8633
Practice Address - Street 1:36 NE EGLIN PARKWAY
Practice Address - Street 2:
Practice Address - City:FT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548
Practice Address - Country:US
Practice Address - Phone:850-243-3111
Practice Address - Fax:850-244-8633
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2010-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC874152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19461ZOtherMEDICARE
FL19461OtherBCBS
FL078299300Medicaid
FL19461OtherBCBS
FLDN680AMedicare UPIN