Provider Demographics
NPI:1538154646
Name:CONSOR, ROBERT S (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:CONSOR
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:PO BOX 200438
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-0438
Mailing Address - Country:US
Mailing Address - Phone:817-784-0222
Mailing Address - Fax:817-467-5819
Practice Address - Street 1:5494 GLEN LAKES DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-4308
Practice Address - Country:US
Practice Address - Phone:214-692-6220
Practice Address - Fax:214-696-1579
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2025-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2227152W00000X
TX2227TG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5967634OtherAETNA
TXTXB135609Medicare PIN
TXT12756Medicare UPIN