Provider Demographics
NPI:1013078575
Name:ASSANTES, ROBERT R (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:R
Last Name:ASSANTES
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 1:2140 CENTERVILLE RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4314
Mailing Address - Country:US
Mailing Address - Phone:850-383-3333
Mailing Address - Fax:850-383-3441
Practice Address - Street 1:2140 CENTERVILLE RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4314
Practice Address - Country:US
Practice Address - Phone:850-383-3322
Practice Address - Fax:850-383-3401
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3206152W00000X
GAOPT001797152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000901337EMedicaid
GA00901337AMedicaid
FL410039102OtherRAILROAD MEDICARE
FL20879OtherBLUE CROSS BLUE SHIELD
FLE1877ZMedicare ID - Type Unspecified