Provider Demographics
NPI:1316954621
Name:TITCOMB, ROBERT EDWARD (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWARD
Last Name:TITCOMB
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 1:1020 INDEPENDENCE BLVD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23455-5500
Mailing Address - Country:US
Mailing Address - Phone:757-460-3688
Mailing Address - Fax:757-460-5516
Practice Address - Street 1:1020 INDEPENDENCE BLVD
Practice Address - Street 2:SUITE 307
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23455-5500
Practice Address - Country:US
Practice Address - Phone:757-460-3688
Practice Address - Fax:757-460-5516
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000523152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA061152OtherANTHEM
VA541237743OtherUSAA
VA541237743OtherAETNA
VA541237743OtherTRICARE
VA541237743OtherMAIL HANDLERS
VAOPTIMA/SENTARAOther300065
VA009206361Medicaid
VA0457980002OtherMEDICARE DME
VA009204008Medicaid
VA2923OtherDAVIS VISION
VA0457980002OtherMEDICARE DME
VA541237743OtherTRICARE