Individual
DR. ROBERT LEE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1401
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0904M
BLUE CROSS OF N C
NC
01
—
10930
PARTNERS MEDICARE CHOICE
NC
01
—
62842
MEDCOST
NC
05
—
890904M
—
NC
Enumeration date
08/01/2005
Last updated
03/12/2008
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