Provider Demographics
NPI:1831363019
Name:DR.ROBERT L. EVANS
Entity type:Organization
Organization Name:DR.ROBERT L. EVANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:619-422-5361
Mailing Address - Street 1:330 OXFORD ST
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-3117
Mailing Address - Country:US
Mailing Address - Phone:619-422-5361
Mailing Address - Fax:619-422-7021
Practice Address - Street 1:330 OXFORD ST
Practice Address - Street 2:SUITE 206
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-3117
Practice Address - Country:US
Practice Address - Phone:619-422-5361
Practice Address - Fax:619-422-7021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4834T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0795700002Medicaid