Individual
MR. JERRY D ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
279 N GARDNER ST, SCOTTSBURG, IN 47170
(812) 752-5106
(812) 752-5132
Mailing address
279 N GARDNER ST, SCOTTSBURG, IN 47170
(812) 752-5106
(812) 752-5132
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18001504A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000109053
ANTHEM
—
01
—
005120
SIHO
—
05
—
100099460B
—
IN
01
—
410010037
RR MEDICARE
—
Enumeration date
12/09/2005
Last updated
11/05/2008
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