Provider Demographics
NPI:1831186238
Name:TAYLOR, ROBERT W (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:109 CROSSROADS RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SCOTTDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15683-2458
Mailing Address - Country:US
Mailing Address - Phone:724-220-2430
Mailing Address - Fax:724-220-2431
Practice Address - Street 1:109 CROSSROADS RD
Practice Address - Street 2:SUITE 108
Practice Address - City:SCOTTDALE
Practice Address - State:PA
Practice Address - Zip Code:15683-2458
Practice Address - Country:US
Practice Address - Phone:724-220-2430
Practice Address - Fax:724-220-2431
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOEG000786152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PATA000063119OtherBLUE SHIELD
PATA63119Medicare ID - Type Unspecified
PAT28052Medicare UPIN
PA0689600001Medicare NSC