DR. ROBERT PROUDFIT OD NPI 1457355158

Optometrist in South Bend, IN

About ROBERT PROUDFIT

Robert Proudfit is a provider in South Bend, IN. The NPI number assigned to this provider is 1457355158. The practitioner's primary taxonomy code is Optometrist (152W00000X). The provider is registered as an individual and their NPI record was last updated 8 years ago.

NPI

1457355158

Additional informationCallout TooltipNational Provider Indentifier (NPI)
The 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
Provider NameDR. ROBERT PROUDFIT OD
Provider Location Address220 N IRONWOOD DRIVE SOUTH BEND, IN 46615 Additional informationCallout TooltipProvider location address
The location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Mailing Address220 N IRONWOOD DRIVE SOUTH BEND, IN 46615 Additional informationCallout TooltipProvider mailing address
The mailing address of the provider being identified. This address may contain the same information as the provider location address.
GenderMale
NPI Entity TypeIndividual Additional informationCallout TooltipEntity type code
The code describing the type of health care provider that is being assigned an NPI.
Codes are:
1 = (Person): individual human being who furnishes health care;
2 = (Non-person): entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO).
Is Sole Proprietor?Yes
Is Organization Subpart?N/A Additional informationCallout TooltipWhat is a subpart?
Subparts are the components and separate physical locations of organization health care providers. Examples include:
Hospital components include outpatient departments, surgical centers, psychiatric units, and laboratories. These components are often separately licensed or certified by States and may exist at physical locations other than that of the hospital of which they are a component.
Enumeration Date06-09-2005 Additional informationCallout TooltipProvider enumeration date
The date the provider was assigned a unique identifier (assigned an NPI)
Last Update Date09-03-2010 Additional informationCallout TooltipLast update date
The date that a record was last updated or changed.

Business Address

DR. ROBERT PROUDFIT OD
220 N IRONWOOD DRIVE
SOUTH BEND, IN
ZIP 46615
Phone: (574) 289-3937
Fax: (574) 280-7355
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Mailing Address

DR. ROBERT PROUDFIT OD
220 N IRONWOOD DRIVE
SOUTH BEND, IN
ZIP 46615
Phone: (574) 289-3937
Fax: (574) 280-7355

Primary Taxonomy

Taxonomy Code152W00000X Additional informationCallout TooltipPrimary Taxonomy Code
The primary taxonomy code defines the provider type, classification, and specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
ClassificationOptometrist
TypeEye and Vision Services Providers
License No.18001502A
License StateIN
Taxonomy DescriptionDoctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.

Additional Identifiers


Additional identifier(s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.

Identifier Type / Code Identifier State
737950AMEDICARE PIN (08)IN
T35012MEDICARE UPIN (02)IN
410001532OTHER (01)IN
000000084930OTHER (01)IN
0550260002MEDICARE NSC (07)IN

Map Location


DR. ROBERT PROUDFIT OD address is 220 N IRONWOOD DRIVE SOUTH BEND, IN 46615
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