Provider Demographics
NPI:1932362795
Name:NORTH, ROBERT W (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:W
Last Name:NORTH
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:2921 ERIE BLVD E
Mailing Address - Street 2:MASS OPTOMETRIC ASSOCIATES, P.C.
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13224-1430
Mailing Address - Country:US
Mailing Address - Phone:315-446-3145
Mailing Address - Fax:315-445-7675
Practice Address - Street 1:726 1/2 BELMONT ST
Practice Address - Street 2:MASS OPTOMETRIC ASSOCIATES, P.C.
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-5602
Practice Address - Country:US
Practice Address - Phone:508-587-9700
Practice Address - Fax:508-587-0646
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA2100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW15242Medicare PIN