Provider Demographics
NPI:1487798658
Name:NIBLE, ROBERT THOMAS (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:THOMAS
Last Name:NIBLE
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 1:801 SHIFFLER AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-3733
Mailing Address - Country:US
Mailing Address - Phone:570-322-7156
Mailing Address - Fax:570-322-9775
Practice Address - Street 1:801 SHIFFLER AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3733
Practice Address - Country:US
Practice Address - Phone:570-322-7156
Practice Address - Fax:570-322-9775
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000017152W00000X, 152WC0802X, 152WP0200X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA396107OtherNATIONAL VISION ASSOCIATI
PA8440OtherGEISINGER HEALTH PLAN
PA072780OtherFIRST PRIORITY HEALTH
PANI575108OtherBLUE SHIELD
PANI575108OtherBLUE SHIELD
PANI575108Medicare ID - Type Unspecified