DR. ROBERT MITCHELL THACKER (NPI# 1003874991) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003874991 |
| Entity Type | Individual |
| Full Name | DR. ROBERT MITCHELL THACKER |
| Credential | O.D. |
| Practice Address |
1466 Broad St Providence RI 02905-2836 |
| Mailing Address |
506 Fish Hill Rd West Greenwich RI 02817-2209 |
| Practice Telephone | 4019416221 |
| Practice Fax Number | 4019416227 |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2013-09-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 152W00000X | Optometrist | ODTA00456 | RI | Eye and Vision Services Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902022320 | Robert E Thacker Jr. | Counselor | 223 S. Walnut Ave., Ames, IA 50010 | 2007-04-17 |
| 1306926621 | Robert K Thacker | Family Medicine | 603a Dolley Madison Rd, Greensboro, NC 27410-4205 | 2006-10-17 |
| 1477652204 | Robert A Thacker | Dentist | 1436 Beauty Circle, Birmingham, AL 35214-3008 | 2006-09-21 |
| 1124309224 | Robert Slade Thacker | Nurse Practitioner | 1906 Fairview Ave, Ste. 230, Caldwell, ID 83605-5407 | 2011-09-01 |
| 1881680973 | Robert E. Thacker | Internal Medicine | 620 10th Street N., St Petersburg, FL 33705-1407 | 2005-09-23 |
| Street Address |
1466 BROAD ST |
| City | PROVIDENCE |
| State | RI |
| Zip Code | 02905-2836 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629074141 | George D Bertherman | Optometrist | 1466 Broad St, Providence, RI 02905-2836 | 2005-06-21 |
| 1326173113 | Didem Kokturk | Optometrist | 1466 Broad St, Providence, RI 02905-2836 | 2007-02-22 |
| 1316072143 | George D. Bertherman,o.d., Inc. | Optometrist | 1466 Broad St, Providence, RI 02905-2836 | 2007-02-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477100808 | Raisa Emilia Garcia-diaz | Counselor | 66 Pavilion Avenue, Providence, RI 02905 | 2019-08-21 |
| 1962976571 | Nike A. Kendall | Social Worker | Program In Women's Oncology, 101 Dudley Street, Providence, RI 02905 | 2019-01-16 |
| 1891265443 | Carolyn Te Young | Pathology | 1320 Narragansett Blvd, Cranston, RI 02905 | 2018-11-27 |
| 1417427071 | Julianne Elizabeth Houtchens | Dietitian, Registered | Adult Primary Care 245 Chapman Street, Providence, RI 02905 | 2018-11-27 |
| 1922577394 | Dilenia C Cruz | Health Educator | 335r Prairie Ave., Suite 2b, Providence, RI 02905 | 2018-11-15 |
| 1639653116 | Varina S. Gunn | Health Educator | 335r Prarie Ave., Suite 2b, Providence, RI 02905 | 2018-09-20 |
| 1427590421 | Cardea Healthcare LLC | In Home Supportive Care | 100 Pavilion Avenue, Suite 101, Providence, RI 02905 | 2016-11-08 |
| 1265884597 | Maxwell King | Physical Therapy Assistant | 48 Moorland Avenue, Cranston, RI 02905 | 2016-07-11 |
| 1346698024 | Samantha Lea Colli | Physician Assistant | 100 Dudley St Fl 3, Providence, RI 02905 | 2016-06-02 |
| 1346697448 | Amy Jean Simpson | Marriage & Family Therapist | 1981 Broad Street, Cranston, RI 02905 | 2016-05-18 |
| Find all providers in zip 02905 | ||||
| Taxonomy Code | 152W00000X |
| Grouping | Eye and Vision Services Providers |
| Classification | Optometrist |
| Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system. |
| Notes: Source: American Optometric Association (AOA), approved by the AOA’s Board of Trustees, June 21, 2005. [7/1/2006: definition modified] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396251740 | Mandalay Optical Labs, LLC | Optometrist | 905 Westminster St, Providence, RI 02903-4020 | 2017-12-21 |
| 1427464510 | Kriti Bhagat | Optometrist | 100 Highland Ave Ste 304, Providence, RI 02906-2753 | 2014-07-09 |
| 1073959151 | East Side Vision Care Inc | Optometrist | 213 Thayer St, Providence, RI 02906-1210 | 2013-05-16 |
| 1528299245 | South Valley Eyecare Center, Inc. | Optometrist | 276 Springcreek Pkwy, Providence, UT 84332 | 2009-07-29 |
| 1588750194 | Leslie Kliethermes | Optometrist | 70 Providence Pl, Providence, RI 02903-1747 | 2006-10-04 |
| 1801981691 | James Lawrence Norton | Optometrist | 740 North Main Street, Providence, RI 02904 | 2006-10-04 |
| 1417067950 | David Alan Smith | Optometrist | 276 N. Springcreek Pkwy, Providence, UT 84332-9707 | 2006-08-30 |
| 1720095953 | John D Corrow | Optometrist | 780 North Main St., Providence, RI 02904 | 2006-08-01 |
| 1982637153 | Earle Ullman Scharff IIi | Optometrist | 55 Dorrance St, Providence, RI 02903-2221 | 2006-07-09 |
| 1205826997 | Paul A De Cesare | Optometrist | 354 Broadway, Providence, RI 02909 | 2005-10-25 |
| Find all providers in PROVIDENCE | ||||
| City | PROVIDENCE |
| Zip Code | 02905 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.