Provider Demographics
NPI:1801979778
Name:BISHOP, ROBERT CLYDE JR
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CLYDE
Last Name:BISHOP
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 BROOKS COVE RD
Mailing Address - Street 2:
Mailing Address - City:CANDLER
Mailing Address - State:NC
Mailing Address - Zip Code:28715-9485
Mailing Address - Country:US
Mailing Address - Phone:828-665-0603
Mailing Address - Fax:
Practice Address - Street 1:17 SARDIS RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28806-8536
Practice Address - Country:US
Practice Address - Phone:828-665-0603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1198156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC40483OtherDAVIS VISION
NC8802013Medicaid
NCNC8802013OtherSERVICES FOR BLIND