Provider Demographics
NPI:1356424840
Name:FLOOD, ROBERT L (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:FLOOD
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:1380 E NAPIER AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BENTON HARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:49022
Mailing Address - Country:US
Mailing Address - Phone:269-926-7277
Mailing Address - Fax:269-925-9027
Practice Address - Street 1:2603 NILES AVE
Practice Address - Street 2:SUITE A
Practice Address - City:SAINT JOSEPH
Practice Address - State:MI
Practice Address - Zip Code:49085-1954
Practice Address - Country:US
Practice Address - Phone:269-926-7277
Practice Address - Fax:269-408-5764
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2010-05-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4901002645152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900A17622OtherBLUE CROSS BLUE SHIELD
MIOP13280Medicare PIN
MIT32642Medicare UPIN