Provider Demographics
NPI:1538167168
Name:ROBERT, TODD ARTHUR (OD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:ARTHUR
Last Name:ROBERT
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 1:3800 HIGHLAND AVE
Mailing Address - Street 2:STE. 100
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-1557
Mailing Address - Country:US
Mailing Address - Phone:630-960-0456
Mailing Address - Fax:630-960-9521
Practice Address - Street 1:3800 HIGHLAND AVE
Practice Address - Street 2:STE. 100
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-1557
Practice Address - Country:US
Practice Address - Phone:630-960-0456
Practice Address - Fax:630-960-9521
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2007-10-08
Deactivation Date:2006-03-15
Deactivation Code:
Reactivation Date:2006-03-21
Provider Licenses
StateLicense IDTaxonomies
IL467829152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01626808OtherBCBS
IL01626807OtherBCBS FOR WESTCHESTER
ILT35510Medicare UPIN
ILL72477Medicare ID - Type Unspecified