Provider Demographics
NPI:1356552053
Name:ROBY OD AND ASSOCIATES PC
Entity type:Organization
Organization Name:ROBY OD AND ASSOCIATES PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ROBY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-331-4441
Mailing Address - Street 1:15437 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:HARVEY
Mailing Address - State:IL
Mailing Address - Zip Code:60426-3306
Mailing Address - Country:US
Mailing Address - Phone:708-331-4441
Mailing Address - Fax:708-331-5520
Practice Address - Street 1:15437 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-3306
Practice Address - Country:US
Practice Address - Phone:708-331-4441
Practice Address - Fax:708-331-5520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008239152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL541200Medicare PIN