Provider Demographics
NPI:1538154646
Name:CONSOR, ROBERT S (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:CONSOR
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:PO BOX 208904
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-8904
Mailing Address - Country:US
Mailing Address - Phone:636-200-4393
Mailing Address - Fax:636-527-0766
Practice Address - Street 1:7638 STONEBROOK PKWY
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1003
Practice Address - Country:US
Practice Address - Phone:972-712-1010
Practice Address - Fax:972-712-1011
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2227TG152WC0802X
TX2227152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0093FBOtherBLUECROSS BLUESHIELD
TXTXB135609Medicare PIN
TXT12756Medicare UPIN