Active NPI
Paul H Roberts, OD.
- Optometrist
- Philadelphia, PA
National Provider Identifier
1326109547
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 0EG001404
- Practice address
- 1348 W Erie Ave
Philadelphia, PA 19140-4254 - Phone
- (215) 223-5000
- Fax
- (215) 223-9180
- NPI assigned
- Dec 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 0EG001404 | PA | Primary |
Addresses
Primary practice location
1348 W Erie Ave
Philadelphia, PA 19140-4254
Mailing address
1348 W Erie Ave
Philadelphia, PA 19140-4254
Phone (215) 223-5000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100965778 | Medicaid | PA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0EG001404 | PA | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Morrell Optical Inc | Optometrist | Past | Accepting new patients |
| Philadelphia Vision Center of Erie Ave Inc | Optometrist | Past | Accepting new patients |
| Morrell Eye Care, Inc. | Optometrist | Past | Accepting new patients |
Organizations & group practices 3
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Optometrist
- Philadelphia, PA
- NPI 1063834141
-
- Eyewear Supplier
- Philadelphia, PA
- NPI 1235378688
Optometrist
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1381795200000",
"number": "1326109547",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1348 W ERIE AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191404254",
"telephone_number": "215-223-5000",
"fax_number": "215-223-9180"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1348 W ERIE AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191404254",
"telephone_number": "215-223-5000",
"fax_number": "215-223-9180"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "PAUL",
"middle_name": "H",
"name_prefix": "Dr.",
"credential": "OD.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-12",
"last_updated": "2013-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "PA",
"license": "0EG001404",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100965778",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.