Individual
DR. ROBERT LEE SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2325 ABERDEEN BLVD, SUITE A, GASTONIA, NC 28054-0614
(704) 853-3937
(704) 853-0840
Mailing address
2325 ABERDEEN BLVD, SUITE A, GASTONIA, NC 28054-0614
(704) 853-3937
(704) 853-0840
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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