Provider Demographics
NPI:1457348617
Name:DYKES, H ROBERT III (OD)
Entity Type:Individual
Prefix:DR
First Name:H
Middle Name:ROBERT
Last Name:DYKES
Suffix:III
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 1:854 EMERALD BAY RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-6438
Mailing Address - Country:US
Mailing Address - Phone:530-544-2020
Mailing Address - Fax:530-544-1838
Practice Address - Street 1:854 EMERALD BAY RD
Practice Address - Street 2:STE C
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-6438
Practice Address - Country:US
Practice Address - Phone:530-544-2020
Practice Address - Fax:530-544-1838
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5141T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0051410Medicaid
CASD0051410Medicaid
CASD0051410Medicare UPIN