Provider Demographics
NPI:1982705919
Name:ROBERTS, STEVE (OD)
Entity Type:Individual
Prefix:
First Name:STEVE
Middle Name:
Last Name:ROBERTS
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 1:4220 JENNY LIND RD
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72901-7660
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4220 JENNY LIND RD
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72901-7660
Practice Address - Country:US
Practice Address - Phone:479-646-5323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2166152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR410000069OtherRAILROAD MEDICARE (PALMETTO)
AR105755722Medicaid
AR48769Medicare ID - Type Unspecified
AR410000069OtherRAILROAD MEDICARE (PALMETTO)
AR0705090001Medicare NSC
AR48769Medicare PIN
48769Medicare PIN