Provider Demographics
NPI:1003675489
Name:ROBERTSON, SPENCER ALLEN (OD)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:ALLEN
Last Name:ROBERTSON
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 1:4989 RIVERS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:FALLON
Mailing Address - State:NV
Mailing Address - Zip Code:89406-1202
Mailing Address - Country:US
Mailing Address - Phone:775-427-6774
Mailing Address - Fax:
Practice Address - Street 1:65 N TAYLOR ST
Practice Address - Street 2:
Practice Address - City:FALLON
Practice Address - State:NV
Practice Address - Zip Code:89406-2750
Practice Address - Country:US
Practice Address - Phone:775-423-8024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-18
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program