Provider Demographics
NPI:1104922020
Name:HATFIELD, ROBERT O (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:O
Last Name:HATFIELD
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 N 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:DODGE CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67801-2315
Mailing Address - Country:US
Mailing Address - Phone:620-227-3071
Mailing Address - Fax:620-227-6911
Practice Address - Street 1:2520 N 14TH AVE
Practice Address - Street 2:
Practice Address - City:DODGE CITY
Practice Address - State:KS
Practice Address - Zip Code:67801-2315
Practice Address - Country:US
Practice Address - Phone:620-227-3071
Practice Address - Fax:620-227-6911
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1397152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100219900AMedicaid
KS410024032OtherRAILROAD MEDICARE
KS410024032OtherRAILROAD MEDICARE
KS100219900AMedicaid