Provider Demographics
NPI:1306877949
Name:HOM, ROBERT G (OD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:HOM
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:G
Other - Last Name:HOM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OPTOMETRIST
Mailing Address - Street 1:5810 TEMPLE CITY BLVD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-2112
Mailing Address - Country:US
Mailing Address - Phone:626-287-9725
Mailing Address - Fax:
Practice Address - Street 1:5810 TEMPLE CITY BLVD
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-2112
Practice Address - Country:US
Practice Address - Phone:626-287-9725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5539TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T70040Medicare UPIN
CASD0055390Medicare ID - Type Unspecified