Provider Demographics
NPI:1912919598
Name:CLEAVER, ROBERT J JR (OD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:CLEAVER
Suffix:JR
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 1:6751 N 72ND ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68122-1746
Mailing Address - Country:US
Mailing Address - Phone:402-572-2020
Mailing Address - Fax:402-572-2150
Practice Address - Street 1:6751 N 72ND ST
Practice Address - Street 2:SUITE 105
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122-1746
Practice Address - Country:US
Practice Address - Phone:402-572-2020
Practice Address - Fax:402-572-2150
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1229152W00000X
IA02319152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE245098OtherMIDLANDS CHOICE
NE239105OtherCOVENTRY
NE37061OtherBCBS NE
NE47067295013Medicaid
IA93682OtherBCBS IA
IA0595835Medicaid
NE239105OtherCOVENTRY
NEP00240162Medicare ID - Type UnspecifiedRAILROAD MEDICARE
NE278916Medicare ID - Type Unspecified
NEV02978Medicare UPIN