Provider Demographics
NPI:1588759138
Name:AMES, ROBERT D (LO)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:D
Last Name:AMES
Suffix:
Gender:M
Credentials:LO
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Mailing Address - Street 1:90 ELM STREET
Mailing Address - Street 2:73 WESTFIELD SHOPPINGTOWN
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082
Mailing Address - Country:US
Mailing Address - Phone:860-741-0893
Mailing Address - Fax:860-741-5271
Practice Address - Street 1:90 ELM STREET
Practice Address - Street 2:73 WESTFIELD SHOPPINGTOWN
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082
Practice Address - Country:US
Practice Address - Phone:860-741-0893
Practice Address - Fax:860-741-5271
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT001377156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0268420001Medicare ID - Type Unspecified