Provider Demographics
NPI:1447218003
Name:NEGRETE, ROBERT R (OD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:R
Last Name:NEGRETE
Suffix:
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 1:116 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-5844
Mailing Address - Country:US
Mailing Address - Phone:641-753-5042
Mailing Address - Fax:641-753-5292
Practice Address - Street 1:116 W MAIN ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-5844
Practice Address - Country:US
Practice Address - Phone:641-753-5042
Practice Address - Fax:641-753-5292
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2015T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
35469OtherGROUP BC BS
IA53102OtherBC BS
IA4110973Medicaid
U44105Medicare UPIN
35469OtherGROUP BC BS
IAI16995Medicare ID - Type Unspecified