Individual
DR. ROBERT KEITH CAUDELLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
320 N JEFF DAVIS DRIVE, SUITE A, FAYETTEVILLE, GA 30214
(770) 461-2633
(770) 461-5792
Mailing address
320 N JEFF DAVIS DRIVE, SUITE A, FAYETTEVILLE, GA 30214
(770) 461-2633
(770) 461-5792
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1043
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0866550001
DMERC
—
01
—
410004213
RAILROAD MEDICARE
—
Enumeration date
07/24/2006
Last updated
12/29/2011
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