Provider Demographics
NPI:1962528844
Name:ROBERT & KIMBERLY MOLTER INC
Entity type:Organization
Organization Name:ROBERT & KIMBERLY MOLTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:MOLTER
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:231-258-9781
Mailing Address - Street 1:PO BOX 2027
Mailing Address - Street 2:
Mailing Address - City:KALKASKA
Mailing Address - State:MI
Mailing Address - Zip Code:49646-2027
Mailing Address - Country:US
Mailing Address - Phone:231-258-9781
Mailing Address - Fax:231-258-0616
Practice Address - Street 1:1008 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-1602
Practice Address - Country:US
Practice Address - Phone:231-547-7800
Practice Address - Fax:231-547-7874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0800300002Medicare ID - Type UnspecifiedMEDICARE MATERIALS
MIOM39690002Medicare ID - Type UnspecifiedMEDICARE
0800300002Medicare NSC