Provider Demographics
NPI:1174654016
Name:MALATIN, ROBERT MARTIN (OD OPTOMETRIST)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MARTIN
Last Name:MALATIN
Suffix:
Gender:M
Credentials:OD OPTOMETRIST
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:MALATIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3114 NORTH PARHAM ROAD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4407
Mailing Address - Country:US
Mailing Address - Phone:804-270-2020
Mailing Address - Fax:804-270-2020
Practice Address - Street 1:3114 NORTH PARHAM ROAD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23294-4407
Practice Address - Country:US
Practice Address - Phone:804-270-2020
Practice Address - Fax:804-270-2020
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA6180000086152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T21739Medicare UPIN
0525530001Medicare PIN