Provider Demographics
NPI:1427058064
Name:COTTER, ROBERT JOHN (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:COTTER
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 1:328 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BRATTLEBORO
Mailing Address - State:VT
Mailing Address - Zip Code:05301-6240
Mailing Address - Country:US
Mailing Address - Phone:802-254-9012
Mailing Address - Fax:802-251-1076
Practice Address - Street 1:328 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6240
Practice Address - Country:US
Practice Address - Phone:802-254-9012
Practice Address - Fax:802-251-1076
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030-0000238152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00019948OtherBLUE CROSS BLUE SHIELD
VTOVN0229Medicaid
VTU27081Medicare UPIN
VTOVN0229Medicaid
VTVN0229Medicare PIN