Provider Demographics
NPI:1457461204
Name:POULIN, ROBERT WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:POULIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 E MICHELTORENA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-2257
Mailing Address - Country:US
Mailing Address - Phone:805-963-4272
Mailing Address - Fax:805-964-6617
Practice Address - Street 1:515 E MICHELTORENA ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-2257
Practice Address - Country:US
Practice Address - Phone:805-963-4272
Practice Address - Fax:805-563-0883
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59821207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ56020ZOtherBLUE SHIELD
CAG59821OtherMEDICAL LISCENSE
CAGR0068400Medicaid
CAG59821OtherMEDICAL LISCENSE
CAB58043Medicare UPIN
CAW3635Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER
ZZZ56020ZOtherBLUE SHIELD
WG59821AMedicare ID - Type Unspecified
CA0813570001Medicare NSC