Provider Demographics
NPI:1912995986
Name:PAIROLERO, ROBBIE J (OD)
Entity Type:Individual
Prefix:
First Name:ROBBIE
Middle Name:J
Last Name:PAIROLERO
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:PO BOX 208177
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-8177
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:5700 MARSH RD
Practice Address - Street 2:
Practice Address - City:HASLETT
Practice Address - State:MI
Practice Address - Zip Code:48840-8987
Practice Address - Country:US
Practice Address - Phone:517-339-4100
Practice Address - Fax:517-339-4199
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004156152WC0802X, 152WX0102X, 152W00000X, 152WL0500X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI383416577OtherVISIOIN SERVICE PLAN
MI94-4434850Medicaid
MI22-70011OtherPHP FAMILYCARE
MI22-00191OtherPHP OF MID MICHIGAN
MI900C365920OtherBLUE CARE NETWORK
MIRP004156OtherBCBSOF MICHIGAN
MIN56260-002Medicare ID - Type Unspecified
MIU92285Medicare UPIN