| Doctor Name: | DR. JERRY TED ROBERTS |
| NPI Number: | 1629032768 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | O.D. |
| License Number: | TX2344TG |
| Business Practice Address: | 1100 Stone Rd Suite 2020 Kilgore, TX - 756625482 |
| Business Phone Number: | 9039832020 |
| Business Fax Number: | 9039834000 |
| Mailing Address: | 1100 Stone Rd, Suite 2020 KILGORE |
| State: | TX |
| Postal Code: | 756625482 |
| Phone Number: | 9039832020 |
| Fax Number: | 9039834000 |
| NPI Enumeration Date: | 04/14/2006 |
| NPI Last Update Date: | 02/11/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 152WC0802X |
| License Number: | TX2344TG |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Optometrist |
| Taxonomy Specialization: | Corneal and Contact Management |
| Taxonomy Definition: | The professional activities performed by an Optometrist related to the fitting of contact lenses to an eye, ongoing evaluation of the cornea |