Organization
DAVID L ROBERTS O D P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID L ROBERTS O.D. (OWNER)
(918) 647-3284
Entity
Organization
Contact information
Practice address
2110 N BROADWAY ST, POTEAU, OK 74953-2501
(918) 647-3284
(918) 647-3394
Mailing address
PO BOX 829, POTEAU, OK 74953-0829
(918) 647-3284
(918) 647-3394
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
781
OK
332H00000X
Eyewear Supplier
781
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100761880A
—
OK
01
—
441409440001
BCBS
OK
01
—
731508474953A001
TRICARE
—
Enumeration date
10/18/2007
Last updated
07/29/2011
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