Active NPI
Robert Souder
- Optician
- Sayre, PA
National Provider Identifier
1467134502
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optician
- License
- 252660
- Practice address
- 1887 Elmira St
Sayre, PA 18840-9249 - Phone
- (607) 249-0942
- Fax
- (570) 888-0713
- NPI assigned
- Aug 7, 2023
- 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 |
|---|---|---|---|---|
| Optician | 156FX1800X | 252660 | PA | Primary |
Addresses
Primary practice location
1887 Elmira St
Sayre, PA 18840-9249
Mailing address
5414 Sheshequin Rd
Ulster, PA 18850-8328
Phone (570) 249-0942
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 252660 | PA | MD | Optician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1691366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691539200000",
"number": "1467134502",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5414 SHESHEQUIN RD",
"city": "ULSTER",
"state": "PA",
"postal_code": "188508328",
"telephone_number": "570-249-0942"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1887 ELMIRA ST",
"city": "SAYRE",
"state": "PA",
"postal_code": "188409249",
"telephone_number": "607-249-0942",
"fax_number": "570-888-0713"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SOUDER",
"first_name": "ROBERT",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-08-07",
"last_updated": "2023-08-09",
"certification_date": "2023-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "156FX1800X",
"taxonomy_group": "",
"desc": "Technician/Technologist, Optician",
"state": "PA",
"license": "252660",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sayre, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.