Provider Demographics
NPI:1982778825
Name:SZELIGA, ROBERT REISS (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:REISS
Last Name:SZELIGA
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 1:5238 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-2443
Mailing Address - Country:US
Mailing Address - Phone:931-489-1950
Mailing Address - Fax:931-489-1953
Practice Address - Street 1:5238 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:TN
Practice Address - Zip Code:37174-2443
Practice Address - Country:US
Practice Address - Phone:931-489-1950
Practice Address - Fax:931-489-1953
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2599152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3732144Medicare ID - Type UnspecifiedGROUP #
TNV07664Medicare UPIN
TN3946763Medicare ID - Type UnspecifiedPERFORMING PROVIDER #