Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 8120T | CA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 8120T | CA |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | 8120T | CA |
N | 152WP0200X | Pediatric Optomitrist | 8120T | CA |
N | 152WS0006X | Sports Vision | 8120T | CA |
N | 152WV0400X | Optomitrist - Vision Therapist | 8120T | CA |
N | 152WX0102X | Occupational Vision | 8120T | CA |
NPI | 1194865576 |
---|---|
Provider Name | Dr. Evan Matthew Roberts |
First Address | Alpine, CA 91901-4105 |
Second Address | Camp Pendleton, CA 92055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2007 |
Last Update Date | 08/07/2007 |