Provider Demographics
NPI:1801898937
Name:NORRIS, ROBERT KENNETH (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KENNETH
Last Name:NORRIS
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 1:600 N WELLWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-2000
Mailing Address - Country:US
Mailing Address - Phone:631-957-0033
Mailing Address - Fax:631-957-2315
Practice Address - Street 1:600C N WELLWOOD AVE
Practice Address - Street 2:# C
Practice Address - City:LINDENHURST
Practice Address - State:NY
Practice Address - Zip Code:11757-2001
Practice Address - Country:US
Practice Address - Phone:631-957-0033
Practice Address - Fax:631-957-2315
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2010-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV004634152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
410036802OtherRAILROAD MEDICARE PTAN
WZT7J1OtherMEDICARE PROVIDER NUMBER
NY02018202Medicaid
C71031Medicare PIN
NY02018202Medicaid
C49861Medicare PIN
1841259793Medicare PIN
1801898937Medicare PIN
410036802OtherRAILROAD MEDICARE PTAN
WZT7J1OtherMEDICARE PROVIDER NUMBER
U32673Medicare UPIN