Provider Demographics
NPI:1316922982
Name:VODVARKA, ROBERT JOSEPH (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:VODVARKA
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 1:414 PARK FOREST CTR
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-8065
Mailing Address - Country:US
Mailing Address - Phone:972-241-8084
Mailing Address - Fax:972-241-8086
Practice Address - Street 1:414 PARK FOREST CTR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-8065
Practice Address - Country:US
Practice Address - Phone:972-241-8084
Practice Address - Fax:972-241-8086
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2057TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX410033055OtherRAILROAD PROVIDER NUMBER
TX1669653051OtherORGANIZATION NPI
TX00386VOtherMEDICARE GROUP NUMBER
TX0513920001Medicare NSC
TX410033055OtherRAILROAD PROVIDER NUMBER
TX8A8260Medicare PIN