Provider Demographics
NPI:1447239637
Name:FONTANA, ROBERT L (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:FONTANA
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 1:1935 LINCOLN WAY
Mailing Address - Street 2:
Mailing Address - City:WHITE OAK
Mailing Address - State:PA
Mailing Address - Zip Code:15131-2401
Mailing Address - Country:US
Mailing Address - Phone:412-673-3010
Mailing Address - Fax:412-673-7799
Practice Address - Street 1:1935 LINCOLN WAY
Practice Address - Street 2:
Practice Address - City:WHITE OAK
Practice Address - State:PA
Practice Address - Zip Code:15131-2401
Practice Address - Country:US
Practice Address - Phone:412-673-3010
Practice Address - Fax:412-673-7799
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001078152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOEG001078OtherSTATE LICENSE
PAOEG001078OtherSTATE LICENSE
PAOEG001078OtherSTATE LICENSE
PAMF0464456OtherDEA NUMBER
PA251384721OtherTAX ID NUMBER