Individual
DAVID A ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1251 LAKELAND HILLS BLVD, LAKELAND, FL 33805-4673
(863) 687-2260
(863) 595-0927
Mailing address
1950 OLD GALLOWS RD, SUITE 520, VIENNA, VA 22182-3990
(703) 847-8899
(703) 991-0514
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
8843-T
CA
152W00000X
Optometrist
Primary
OPC2385
FL
152WC0802X
Corneal and Contact Management Optometrist
OPC2385
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11840789
CAQH
—
01
—
V12404
UPIN
—
Enumeration date
12/15/2006
Last updated
04/09/2016
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