Provider Demographics
NPI:1962578823
Name:ROBERT E TITCOMB OFFICE
Entity type:Organization
Organization Name:ROBERT E TITCOMB OFFICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:TITCOMB
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:757-331-2020
Mailing Address - Street 1:217 MASON AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CHARLES
Mailing Address - State:VA
Mailing Address - Zip Code:23310-3201
Mailing Address - Country:US
Mailing Address - Phone:757-331-2020
Mailing Address - Fax:757-331-4077
Practice Address - Street 1:217 MASON AVE
Practice Address - Street 2:
Practice Address - City:CAPE CHARLES
Practice Address - State:VA
Practice Address - Zip Code:23310-3201
Practice Address - Country:US
Practice Address - Phone:757-331-2020
Practice Address - Fax:757-331-4077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000523152W00000X, 152WC0802X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2923OtherDAVIS
VA212922ML2OtherMAMSI
VA009206361Medicaid
VAP00124443OtherRAILROAD MEDICARE
VA117672OtherEYEMED COLE VISION
VA212922ML2OtherOPTIMUM CHOICE
VA212922ML2OtherMAMSI
VA212922ML2OtherMAMSI