Provider Demographics
NPI:1508027343
Name:MORGAN, ROBERT R (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:R
Last Name:MORGAN
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 1:1330 INTERSTATE PKWY
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-5625
Mailing Address - Country:US
Mailing Address - Phone:706-651-2020
Mailing Address - Fax:706-651-2037
Practice Address - Street 1:1330 INTERSTATE PKWY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-5625
Practice Address - Country:US
Practice Address - Phone:706-651-2020
Practice Address - Fax:706-651-2037
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002458152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA724809439BMedicaid
SCDG2458Medicaid