Provider Demographics
NPI:1144461864
Name:ROBERT L. LIVINGSTON, O.D.P.C.
Entity type:Organization
Organization Name:ROBERT L. LIVINGSTON, O.D.P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVINGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:ODPC
Authorized Official - Phone:712-336-8939
Mailing Address - Street 1:PO BOX 317
Mailing Address - Street 2:
Mailing Address - City:SPIRIT LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:51360-0317
Mailing Address - Country:US
Mailing Address - Phone:712-336-8939
Mailing Address - Fax:712-336-8952
Practice Address - Street 1:2600 HIGHWAY 9/71
Practice Address - Street 2:
Practice Address - City:SPIRIT LAKE
Practice Address - State:IA
Practice Address - Zip Code:51360-7257
Practice Address - Country:US
Practice Address - Phone:712-336-8939
Practice Address - Fax:712-336-8952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01647152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA205-179Medicaid
IA1932183720OtherNPI NUMBER
IAT49242Medicare UPIN