Provider Demographics
NPI:1811945827
Name:GOTSCHALK, ROBERT BLUNT (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:BLUNT
Last Name:GOTSCHALK
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 1:2624 BUCKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-9372
Mailing Address - Country:US
Mailing Address - Phone:919-774-1070
Mailing Address - Fax:
Practice Address - Street 1:1225 CARTHAGE ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-8984
Practice Address - Country:US
Practice Address - Phone:919-774-3556
Practice Address - Fax:919-774-7356
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1190152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909322Medicaid
NC09322OtherBCBS OF NC
NC410014666OtherRAILROAD MEDICARE
NC8909322Medicaid
NCT65091Medicare UPIN
NC0153710001Medicare NSC