Provider Demographics
NPI:1881744969
Name:FELKER, ROBERT S (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:FELKER
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 1:808 E WAKEFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-5147
Mailing Address - Country:US
Mailing Address - Phone:573-472-2900
Mailing Address - Fax:573-471-8384
Practice Address - Street 1:808 E WAKEFIELD AVE
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5147
Practice Address - Country:US
Practice Address - Phone:573-472-2900
Practice Address - Fax:573-471-8384
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02554152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO57815OtherANTHEM/BCBS
MO311867717Medicaid
MO311867717Medicaid
MO57815OtherANTHEM/BCBS
MO000007871Medicare PIN